Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800, Feldkirch, Austria.
Department of Surgery, Hospital St. John of God, Graz, Austria.
Int J Colorectal Dis. 2021 Jul;36(7):1469-1477. doi: 10.1007/s00384-021-03923-9. Epub 2021 Apr 6.
The concept of complete mesocolic excision (CME) in right-sided colorectal cancer is well known for open and laparoscopic surgery. The aim of this study was to evaluate and compare perioperative and oncological outcomes of reduced port and open surgery for right-sided colorectal cancer.
One hundred forty-one patients received elective surgery for right-sided colonic cancer between January 2015 and December 2019 and were included in a retrospective database.
We observed longer operation time in the RP-CME group (145 min vs. 119.43 min, p<0.01). Hospital stay (8 days vs. 14 days, p<0.01) and time to first intestinal passage (42 h. vs. 59 h, p<0.01) were significantly shorter in the reduced port group. Postoperative complications were more likely to be observed in the O-CME group (7.2% vs. 14.1%, p=0.28); anastomotic leakage rate was low in both groups (1.8% vs. 2.4%, p=1.00). Specimen scores (score 1= good: 93.8% vs. 91.7%, p=1.00) and average number of retrieved lymph nodes were comparable (24 vs. 23 p=0.69). In O-CME patients, we observed more advanced tumor stages (UICC III: 21.4% vs. 45.9%, p<0.01).
To our knowledge, this is the first study comparing reduced port to open surgery for right-sided colorectal cancer. We could demonstrate that this technique is feasible for oncological right hemicolectomy with observation of shorter hospital stay and lower morbidity rates compared to open surgery. The oncological outcome did not differ in the present study.
完整结肠系膜切除术（CME）的概念在开腹和腹腔镜手术中已经得到广泛认可。本研究旨在评估和比较右半结直肠癌经减少端口和开放手术的围手术期和肿瘤学结果。
2015 年 1 月至 2019 年 12 月期间，141 例接受择期右半结肠癌手术的患者被纳入回顾性数据库。
我们观察到 RP-CME 组的手术时间更长（145 分钟比 119.43 分钟，p<0.01）。减少端口组的住院时间（8 天比 14 天，p<0.01）和首次肠道通过时间（42 小时比 59 小时，p<0.01）明显更短。O-CME 组术后并发症更常见（7.2%比 14.1%，p=0.28）；两组吻合口漏发生率均较低（1.8%比 2.4%，p=1.00）。标本评分（评分 1=良好：93.8%比 91.7%，p=1.00）和平均淋巴结检出数相当（24 个比 23 个，p=0.69）。在 O-CME 患者中，我们观察到更多的肿瘤晚期（UICC III：21.4%比 45.9%，p<0.01）。
据我们所知，这是第一项比较右半结肠癌减少端口与开放手术的研究。我们可以证明，与开放手术相比，这种技术对于右半结肠的肿瘤学切除术是可行的，并且观察到住院时间更短，发病率更低。在本研究中，肿瘤学结果没有差异。
