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一期开腹和/或腹腔镜结直肠癌原发灶与同步肝转移灶切除术:一项观察性研究。

Open and/or laparoscopic one-stage resections of primary colorectal cancer and synchronous liver metastases: An observational study.

机构信息

Department of Surgical Oncology.

Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine.

出版信息

Medicine (Baltimore). 2021 Mar 19;100(11):e25205. doi: 10.1097/MD.0000000000025205.

Abstract

One-stage resections of primary colorectal cancer and liver metastases have been reported to be feasible and safe. Minimally invasive approaches have become more common for both colorectal and hepatic surgeries. This study aimed to investigate outcomes of these combined surgical procedures among different approaches.We retrospectively analyzed patients diagnosed as having primary colorectal cancer with synchronous liver metastases and who underwent 1-stage primary resection and hepatectomy with curative intent in our hospital. According to the surgical approach for the primary tumor and hepatic lesions, namely open laparotomy (Op) or laparoscopic approach (Lap), patients were classified into Op-Op, Lap-Op (laparoscopic colorectal resection plus open hepatectomy), and Lap-Lap groups, respectively. Clinicopathological factors were reviewed, and short- and long-term outcomes were compared among the groups.The Op-Op, Lap-Op, and Lap-Lap groups comprised 36, 18, and 17 patients, respectively. The superior/posterior hepatic segments were more frequently resected via an open approach. There was no laparoscopic major hepatectomy. The median volume of intraoperative blood loss was smaller in the Lap-Lap and Lap-Op groups (290 and 270 mL) than in the Op-Op group (575 mL, P = .008). The hospital stay after surgery was shorter in the Lap-Lap and Lap-Op groups (median: 17 days and 15 days, vs 19 days for the Op-Op group, P = .033). The postoperative complication rates and survivals were similar among the groups.Application of laparoscopy to 1-stage resections of primary colorectal cancer and liver metastases may offer advantages of enhanced recovery from surgical treatment, given appropriate patient selection.

摘要

一期切除原发结直肠癌和肝转移瘤已被证明是可行和安全的。微创方法在结直肠和肝脏手术中变得越来越普遍。本研究旨在探讨不同方法联合手术的结果。

我们回顾性分析了在我院接受一期原发灶和肝转移灶根治性切除的同时诊断为原发结直肠癌伴同步肝转移的患者。根据原发肿瘤和肝病变的手术方式,即开腹手术(Op)或腹腔镜手术(Lap),将患者分为 Op-Op、Lap-Op(腹腔镜结直肠切除术加开腹肝切除术)和 Lap-Lap 组。回顾性分析临床病理因素,并比较各组的短期和长期结果。

Op-Op、Lap-Op 和 Lap-Lap 组分别包括 36、18 和 17 例患者。上/后肝段更常通过开腹手术切除。没有腹腔镜下肝叶切除术。Lap-Lap 和 Lap-Op 组的术中出血量中位数(290 和 270ml)明显少于 Op-Op 组(575ml,P=0.008)。Lap-Lap 和 Lap-Op 组的术后住院时间明显短于 Op-Op 组(中位数:17 天和 15 天,Op-Op 组为 19 天,P=0.033)。各组术后并发症发生率和生存率相似。

在适当的患者选择下,腹腔镜应用于一期切除原发结直肠癌和肝转移瘤可能具有促进手术治疗康复的优势。

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