Chung Hyuk-Jun, Kim Jun-Gi, Kim Hyung-Jin, Cho Hyeon-Min, Kye Bong-Hyeon
Department of Surgery, Mulago National Referral Hospital, Kampala P.O. Box 7051, Uganda.
Department of Surgery, Pyeongtaek St. Mary's Hospital, Pyeongtaek 17825, Korea.
Biomedicines. 2021 Nov 19;9(11):1720. doi: 10.3390/biomedicines9111720.
In this work we intend to validate the long-term oncologic outcomes for very low rectal cancer over the past 20 years and to determine whether laparoscopic procedures are useful options for very low rectal cancer. A total of 327 patients, who electively underwent laparoscopic rectal cancer surgery for a lesion within 5 cm from the anal verge, were enrolled in this study and their long-term outcomes were reviewed retrospectively. Of 327 patients, 70 patients underwent laparoscopic low anterior resection (LAR), 164 underwent laparoscopic abdominal transanal proctosigmoidocolectomy with coloanal anastomosis (LATA), and 93 underwent laparoscopic abdominoperineal resection (APR). The conversion rate was 1.22% (4/327). The overall postoperative morbidity rate was 26.30% (86/327). The 5-year disease free survival (DFS), 5-year overall survival (OS), and 3-year local recurrence (LR) were 64.3%, 79.7%, and 9.2%, respectively. The CRM involvement was a significant independent factor for DFS ( = 0.018) and OS ( = 0.042) in multivariate analysis. Laparoscopic APR showed poorer 5-year DFS (47.8%), 5-year OS (64.0%), and 3-year LR (17.6%) than laparoscopic LAR (74.1%, 86.4%, 1.9%) and laparoscopic LATA (69.2%, 83.6%, 9.2%). Laparoscopic procedures for very low rectal cancer including LAR, LATA, and APR could be good surgical options in selective patients with very low rectal cancer.
在本研究中，我们旨在验证过去20年中极低位置直肠癌的长期肿瘤学结局，并确定腹腔镜手术是否是极低位置直肠癌的有效治疗选择。本研究共纳入327例因距肛缘5 cm以内病变而择期接受腹腔镜直肠癌手术的患者，并对其长期结局进行回顾性分析。327例患者中，70例行腹腔镜低位前切除术（LAR），164例行腹腔镜经腹经肛门直肠乙状结肠切除术并结肠肛管吻合术（LATA），93例行腹腔镜腹会阴联合切除术（APR）。中转率为1.22%（4/327）。术后总体并发症发生率为26.30%（86/327）。5年无病生存率（DFS）、5年总生存率（OS）和3年局部复发率（LR）分别为64.3%、79.7%和9.2%。多因素分析显示，环周切缘受累是DFS（P = 0.018）和OS（P = 0.042）的显著独立因素。腹腔镜APR的5年DFS（47.8%）、5年OS（64.0%）和3年LR（17.6%）均低于腹腔镜LAR（74.1%、86.4%、1.9%）和腹腔镜LATA（69.2%、83.6%、9.2%）。对于极低位置直肠癌患者，包括LAR、LATA和APR在内的腹腔镜手术可能是较好的手术选择。
