腹腔镜结肠切除术：术后腹膜转移的一个危险因素。

Laparoscopic Colectomy: A Risk Factor for Postoperative Peritoneal Metastasis.

作者信息

Nagata Hiroshi, Kawai Kazushige, Oba Koji, Nozawa Hiroaki, Yamauchi Shinichi, Sugihara Kenichi, Ishihara Soichiro

机构信息

Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

出版信息

Clin Colorectal Cancer. 2022 Sep;21(3):e205-e212. doi: 10.1016/j.clcc.2022.05.003. Epub 2022 May 18.

DOI:10.1016/j.clcc.2022.05.003

PMID:35691832

Abstract

BACKGROUND

The oncologic outcomes are generally considered equivalent for both laparoscopic and open surgery. However, our previous single-center study found a greater risk of postoperative peritoneal metastasis (PM) after laparoscopic colectomy (LC) than after open colectomy (OC) in patients with pathological T4a (pT4a) colon cancer. This multicenter study aimed to clarify if the risk of PM was increased after LC.

METHODS

This study used the multicenter database of the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer, which included patients with colorectal cancer treated between 1997 and 2012 in 24 referral hospitals across Japan. The analysis included 17,323 patients with pathological stage I-III colon cancer, including 2380 patients with pT4a disease. The risk of PM was compared between the LC and OC groups.

RESULTS

The cumulative incidence of PM was significantly higher after LC in patients with pT4a colon cancer (13.0% vs. 7.7%; P = .001). Multivariable analyses showed LC was a significant risk factor for PM (hazard ratio [HR]: 1.36, 95% confidence interval [CI]: 1.04-1.78, P = .023), which was confirmed by propensity score analyses (HR: 1.36, 95% CI: 1.04-1.78, P = .024).

CONCLUSION

This study demonstrated a significant increase in the risk of PM after LC than after OC.

摘要

背景

一般认为腹腔镜手术和开放手术的肿瘤学结局相当。然而，我们之前的单中心研究发现，在病理T4a（pT4a）结肠癌患者中，腹腔镜结肠切除术（LC）后发生术后腹膜转移（PM）的风险高于开放结肠切除术（OC）。这项多中心研究旨在明确LC后PM风险是否增加。

方法

本研究使用了日本结直肠癌术后随访研究组的多中心数据库，该数据库纳入了1997年至2012年期间在日本24家转诊医院接受治疗的结直肠癌患者。分析包括17323例病理分期为I - III期的结肠癌患者，其中2380例为pT4a疾病患者。比较了LC组和OC组的PM风险。

结果

pT4a结肠癌患者中，LC后PM的累积发生率显著更高（13.0%对7.7%；P = 0.001）。多变量分析显示LC是PM的显著危险因素（风险比[HR]：1.36，95%置信区间[CI]：1.04 - 1.78，P = 0.023），倾向评分分析也证实了这一点（HR：1.36，95% CI：1.04 - 1.78，P = 0.024）。