Bao Feng, Wu Li-Rong, Deng Zhi-Gang, Xiang Chun-Hua, Shang Jian-Ying
Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China.
J Minim Access Surg. 2023 Apr-Jun;19(2):263-271. doi: 10.4103/jmas.jmas_81_22.
The prognosis of middle-aged patients with colorectal cancer (CRC) treated by laparoscopic resection (LR) is unclear. This study aimed to evaluate the survival outcomes of LR compared with open resection (OR) for middle-aged patients with CRC.
This retrospective cohort study used the data from a database of all consecutive colorectal resections performed between January 2009 and December 2017. Propensity score matching (PSM) was performed to handle the selection bias based on age, gender, body mass index, tumour location, AJCC stage and admission year. Univariate and multivariate COX regression model was used to identify risk factors of overall survival (OS) and disease-free survival (DFS).
After PSM, 154 patients were included in each group. Compared with the OR group in the total cohort, there were better survival outcomes in the LR group for 5-year OS and 5-year DFS (both P < 0.001). These differences were observed for Stage II and III diseases and for all CRC, irrespective of location. The multivariate analysis showed that tumour ≥5 cm (hazard ratio [HR] = 1.750, 95% confidence interval [CI]: 1.026-2.986, P = 0.040), Stage III (HR = 14.092, 95% CI: 1.894-104.848, P = 0.010) and LR (HR = 0.300, 95% CI: 0.160-0.560, P < 0.001) were independently associated with OS. Pre-operative carcinoembryonic antigen ≥5 ng/ml (HR = 3.954, 95% CI: 1.363-11.473, P = 0.011), Stage III (HR = 6.206, 95% CI: 1.470-26.200, P = 0.013) and LR (HR = 0.341, 95% CI: 0.178-0.653, P = 0.001) were independently associated with DFS.
In middle-aged patients with CRC, LR achieves better survival than OR. Complications are similar, except for less blood loss and shorter post-surgical hospital stay with LR.
腹腔镜切除术（LR）治疗中年结直肠癌（CRC）患者的预后尚不清楚。本研究旨在评估LR与开放切除术（OR）相比治疗中年CRC患者的生存结局。
这项回顾性队列研究使用了2009年1月至2017年12月期间所有连续结直肠切除术数据库中的数据。采用倾向评分匹配（PSM）来处理基于年龄、性别、体重指数、肿瘤位置、美国癌症联合委员会（AJCC）分期和入院年份的选择偏倚。使用单因素和多因素COX回归模型来确定总生存（OS）和无病生存（DFS）的危险因素。
PSM后，每组纳入154例患者。与总队列中的OR组相比，LR组的5年OS和5年DFS生存结局更好（均P<0.001）。在II期和III期疾病以及所有CRC中，无论肿瘤位置如何，均观察到这些差异。多因素分析显示，肿瘤≥5 cm（风险比[HR]=1.750，95%置信区间[CI]：1.026 - 2.986，P = 0.040）、III期（HR = 14.092，95%CI：1.894 - 104.848，P = 0.010）和LR（HR = 0.300，95%CI：0.160 - 0.560，P<0.001）与OS独立相关。术前癌胚抗原≥5 ng/ml（HR = 3.954，95%CI：1.363 - 11.473，P = 0.011）、III期（HR = 6.206，95%CI：1.470 - 26.200，P = 0.013）和LR（HR = 0.341，95%CI：0.178 - 0.653，P = 0.001）与DFS独立相关。
在中年CRC患者中，LR的生存效果优于OR。并发症相似，但LR的失血量更少，术后住院时间更短。
