Samalavicius Narimantas Evaldas, Kuliesius Zygimantas, Samalavičius Robertas Stasys, Tikuisis Renatas, Smolskas Edgaras, Gricius Zilvinas, Kavaliauskas Povilas, Dulskas Audrius
Department of Surgery, Klaipeda University Hospital, 92288 Klaipeda, Lithuania.
Health Research and Innovation Science, Faculty of Health Sciences, Klaipeda University, 92294 Klaipeda, Lithuania.
J Clin Med. 2022 Jun 29;11(13):3781. doi: 10.3390/jcm11133781.
The aim of this study was to report overall experience, perioperative and long-term survival results in a single tertiary referral center in Lithuania with hand assisted laparoscopic surgery (HALS) for colorectal cancer. A prospectively maintained database included 467 patients who underwent HALS for left-sided colon and rectal cancer, from April 2006 to October 2016. All those operations were performed by three consultant surgeons and nine surgical residents, in all cases assisted by one of the same consultant surgeons. There were 230 (49.25%) females, with an average age of 64 ± 9.7 years (range, 26-91 years). The procedures performed included 170 (36.4%) anterior rectal resections with partial mesorectal excision, 160 (34.26%) sigmoid colectomies, 81 (17.35%) left hemicolectomies, 45 (9.64%) low anterior rectal resections with total mesorectal excision, and 11 (2.25%) other procedures. Stage I colorectal cancer was found in 140 (29.98%) patients, 139 (29.76%) stage II, 152 (32.55%) stage III and 36 (7.71%) stage IV. There were five conversions to open surgery (1.1%). The mean postoperative hospital stay was 6.9 ± 3.4 days (range, 1-30 days). In total, 33 (7.06%) patients developed postoperative complications. The most common complications were small bowel obstruction ( = 6), anastomotic leakage ( = 5), intraabdominal abscess ( = 4) and dysuria ( = 4). There were two postoperative deaths (0.43%). Overall, 5-year survival for all TNM stages was 85.7%, 93.2% for stage I, 88.5% for stage II and 76.3% for stage III. Hand assisted colorectal surgery for left-sided colon and rectal cancer in a single tertiary referral center was feasible and safe, having all the advantages of minimally invasive surgery, with good perioperative parameters, adequate oncological quality and excellent survival.
本研究旨在报告立陶宛一家三级转诊中心采用手辅助腹腔镜手术（HALS）治疗结直肠癌的总体经验、围手术期及长期生存结果。一个前瞻性维护的数据库纳入了2006年4月至2016年10月期间因左侧结肠癌和直肠癌接受HALS手术的467例患者。所有这些手术均由三位顾问外科医生和九名外科住院医师进行，所有病例均由同一位顾问外科医生之一协助。有230名女性（49.25%），平均年龄为64±9.7岁（范围26 - 91岁）。所进行的手术包括170例（36.4%）直肠前切除术伴部分直肠系膜切除、160例（34.26%）乙状结肠切除术、81例（17.35%）左半结肠切除术、45例（9.64%）直肠低位前切除术伴全直肠系膜切除以及11例（2.25%）其他手术。140例（29.98%）患者为I期结直肠癌，139例（29.76%）为II期，152例（32.55%）为III期，36例（7.71%）为IV期。有5例转为开放手术（1.1%）。术后平均住院时间为6.9±3.4天（范围1 - 30天）。总共有33例（7.06%）患者出现术后并发症。最常见的并发症是小肠梗阻（6例）、吻合口漏（5例）、腹腔内脓肿（4例）和排尿困难（4例）。有2例术后死亡（0.43%）。总体而言，所有TNM分期的5年生存率为85.7%，I期为93.2%，II期为88.5%，III期为76.3%。在单一的三级转诊中心，手辅助结直肠手术治疗左侧结肠癌和直肠癌是可行且安全的，具有微创手术的所有优点，围手术期参数良好，肿瘤学质量足够且生存情况优异。
