Department of General Surgery, Anhui Provincial Hospital Affiliated to the Anhui Medical University.
Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Hefei, China.
Surg Laparosc Endosc Percutan Tech. 2021 Jul 21;31(6):734-741. doi: 10.1097/SLE.0000000000000979.
Laparoscopic resection for rectal cancer has been gaining popularity over the past 2 decades. Whether elderly patients had more benefits from laparoscopy-assisted anterior resection (LAR) need further investigation when comparing with open anterior resection (OAR).
This study aimed to evaluate the clinical outcomes and prognosis of LAR in elderly patients (65 y and above) with rectal cancer and investigate the factors associated with the anastomotic leakage (AL). Besides, the study sought to create a nomogram for precise prediction of AL after anterior resection for rectal cancer.
A total of 343 rectal cancer patients over 65 years old who underwent LAR or OAR at a single center between January 2013 to January 2021 were retrospectively reviewed. Univariate analysis was conducted to explore potential risk factors for AL, and a nomogram for AL was created based on the multivariate logistic regression model.
A total of 343 patients were included in this study, 271 patients in LAR group and 72 patients in OAR group. Most of the variables were comparable between the 2 groups. The mean operative time was longer in the LAR group than that in the OAR group (191.66±58.33 vs. 156.85±53.88 min, P<0.0001). The LAR group exhibited a significantly lower intraoperative blood loss than the OAR group (85.17±50.03 vs. 131.67±79.10 mL; P<0.0001). Moreover, laparoscopic surgery resulted in shorter postoperative hospital stay, lower rates of diverting stoma and receiving sphincter sparing surgery in comparison with open surgery. The overall rates of complications were 25.1% and 40.3% in the LAR and OAR groups (P=0.011), respectively. And the reoperation rates in the OAR group (0%) was lower than in the LAR group (1.5%), but the difference did not reach statistical significance (P=0.300). Sex, location of tumor, diverting stoma and combined organ resection were identified as independent risk factors for AL based on multivariate analysis. Such factors were selected to develop a nomogram. After a median follow-up of 37.0 months, our study showed no significant difference in overall survival or disease free survival between the 2 groups for treatment of rectal cancer.
This study suggests that LAR is an alternative minimally invasive surgical procedure in patients above 65 years with better short-term outcomes and acceptable long-term outcomes compared with OAR. In addition, our nomogram has satisfactory accuracy and clinical utility may benefit for clinical decision-making.
腹腔镜直肠切除术在过去的 20 年中越来越受欢迎。与开放性前切除术（OAR）相比，老年患者是否从腹腔镜辅助前切除术（LAR）中获益更多，这需要进一步研究。
本研究旨在评估 LAR 在 65 岁及以上老年直肠癌患者中的临床效果和预后，并探讨与吻合口漏（AL）相关的因素。此外，本研究旨在创建一个列线图，以精确预测直肠癌前切除术后的 AL。
回顾性分析 2013 年 1 月至 2021 年 1 月期间在一家中心接受 LAR 或 OAR 的 343 例 65 岁以上直肠癌患者的临床资料。采用单因素分析探讨 AL 的潜在危险因素，并基于多因素 logistic 回归模型创建 AL 列线图。
本研究共纳入 343 例患者，LAR 组 271 例，OAR 组 72 例。两组大多数变量无统计学差异。LAR 组的手术时间明显长于 OAR 组（191.66±58.33 分钟 vs. 156.85±53.88 分钟，P<0.0001）。LAR 组术中出血量明显少于 OAR 组（85.17±50.03 毫升 vs. 131.67±79.10 毫升，P<0.0001）。此外，与开放性手术相比，腹腔镜手术术后住院时间更短，预防性造口和保肛手术的比例更低。LAR 组和 OAR 组的并发症总发生率分别为 25.1%和 40.3%（P=0.011），OAR 组的再次手术率（0%）低于 LAR 组（1.5%），但差异无统计学意义（P=0.300）。多因素分析显示，性别、肿瘤位置、预防性造口和联合器官切除是 AL 的独立危险因素。根据这些因素制定了一个列线图。在中位随访 37.0 个月后，两组在直肠癌治疗方面的总生存率和无病生存率无显著差异。
本研究表明，对于 65 岁以上的患者，LAR 是一种替代的微创手术方法，与 OAR 相比，具有更好的短期效果和可接受的长期效果。此外，我们的列线图具有令人满意的准确性和临床实用性，可能有助于临床决策。
