手辅助腹腔镜手术（HALS）在老年（≥80岁）原发性结直肠癌患者中的疗效。
Efficacy of hand-assisted laparoscopic surgery (HALS) in older adult patients (≥80 years) with primary colorectal cancer.
作者信息
Koike Takuya, Mukai Masaya, Abe Rin, Kamei Yutaro, Yokoyama Daiki, Uda Shuji, Higami Shigeo, Hasegawa Sayuri, Nakamura Tomoki, Tajima Takayuki, Nomura Eiji, Makuuchi Hiroyasu
机构信息
Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan.
Tokai University Tokyo Hospital, Department of Surgery, Shibuya-ku, Tokyo, Japan.
出版信息
J Gastrointest Oncol. 2022 Jun;13(3):1073-1080. doi: 10.21037/jgo-21-838.
BACKGROUND
From 2004 to 2014, 821 colorectal cancer primary resections were conducted at our institution. Of these, 102 patients (12.4%) were older adults over 80 years old. underwent either the conventional laparotomy group (72 patients) or the hand-assisted laparoscopic surgery (HALS) group (30 patients).
METHODS
Data were extracted for 102 patients over 80 years old who underwent primary resection for colorectal cancer and were divided into two groups: conventional laparotomy (CL) (n=72) and hand-assisted laparoscopy (n=30). Pre-operative characteristics and outcomes were compared.
RESULTS
Baseline characteristics were similar between groups, except for age: CL group median 83.5 years old (range, 80-92 years old) and hand-assisted laparoscopy (HALS) group median 81.5 years old (range, 80-88 years old) (P=0.027). Pre-operative cardiac and lung function risk, performance status, and pathological classification stage (pStage) were almost similar between groups (P=0.668, P=0.176, P>0.999, P=0.217). No significant differences were found for operation time. The HALS group resulted in less blood loss (median 204 mL in the CL group and median 68 mL in the HALS group, P=0.003), shorter postoperative hospital stay (median was 18 days in the CL group and median was 12 days in the HALS group, P<0.001), and fewer postoperative wound infections (18 cases in the CL group and 2 cases in the HALS group, P=0.034). Five-year relapse-free survival (5Y-RFS) was 48.1% in the CL group and 73.3% in the HALS group (P=0.028). Five-year overall survival (5Y-OS) was 48.2% in the CL group and 73.3% in the HALS group (P=0.027).
CONCLUSIONS
Approximately 70% of surgical treatment for patients over 80 years old with colorectal carcinoma were performed by CL. However, HALS had significant advantages including less blood loss, fewer wound infections, and shorter hospital stays. Therefore, HALS could proactively be considered to older adult patients with colorectal cancer.
背景
2004年至2014年，我院共进行了821例结直肠癌一期切除术。其中，102例患者（12.4%）为80岁以上的老年人，分别接受了传统开腹手术组（72例患者）或手辅助腹腔镜手术（HALS）组（30例患者）。
方法
提取102例80岁以上接受结直肠癌一期切除术患者的数据，并分为两组：传统开腹手术（CL）组（n = 72）和手辅助腹腔镜手术组（n = 30）。比较术前特征和手术结果。
结果
两组患者的基线特征相似，但年龄除外：CL组中位年龄83.5岁（范围80 - 92岁），手辅助腹腔镜手术（HALS）组中位年龄81.5岁（范围80 - 88岁）（P = 0.027）。两组患者术前心脏和肺功能风险、体能状态及病理分类分期（pStage）几乎相似（P = 0.668、P = 0.176、P>0.999、P = 0.217）。手术时间无显著差异。HALS组术中出血量更少（CL组中位出血量204 mL，HALS组中位出血量68 mL，P = 0.003），术后住院时间更短（CL组中位住院时间为18天，HALS组中位住院时间为12天，P<0.001），术后伤口感染更少（CL组18例，HALS组2例，P = 0.034）。CL组的5年无复发生存率（5Y - RFS）为48.1%，HALS组为73.3%（P = 0.028）。CL组的5年总生存率（5Y - OS）为48.2%，HALS组为73.3%（P = 0.027）。
结论
80岁以上结直肠癌患者约70%的手术治疗采用传统开腹手术。然而，手辅助腹腔镜手术具有显著优势，包括出血量更少、伤口感染更少以及住院时间更短。因此，对于老年结直肠癌患者可积极考虑采用手辅助腹腔镜手术。
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