腹腔镜与开腹结肠癌根治术治疗 T4 和/或 N2 期结肠癌患者的中期疗效比较：基于倾向评分匹配分析的多中心研究
Mid-term outcomes of laparoscopic vs open colectomy for pathological T4 and/or N2 colon cancer patients: Multicenter study using propensity score matched analysis.
机构信息
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Surgery, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.
出版信息
Asian J Endosc Surg. 2023 Jul;16(3):400-408. doi: 10.1111/ases.13171. Epub 2023 Feb 17.
OBJECTIVES
We aimed to assess mid-term outcomes after laparoscopic surgery (LAP) vs open surgery (OP) for pathological T4 (pT4) and/or N2 (pN2) colon cancer.
METHODS
We retrospectively reviewed 255 primary tumor resections for pT4 and/or pN2 colon cancer performed from 2015 to 2020 at six hospitals, divided into LAP (n = 204) and OP groups (n = 51). After propensity score matching to minimize selection bias, 47 matched patients per group were assessed.
RESULTS
Before matching, the rate of males (53.9% vs. 37.3%, P = .042), left sided colon cancer (53.9% vs 37.3%, P = .042), D3 lymph node dissection (90.7% vs 68.6%, P < .001) and body mass index (kg/m ) (22.3 vs 21.8, P = .039) were significantly greater in the LAP group. The rate of pT4b (7.8% vs 40.4%, P < .001) was lower and pN2 was higher (57.4% vs 37.3%, P = .012) in the LAP group. After matching, preoperative characteristics and pathologic status were equivalent between the groups. The LAP and OP groups showed comparable overall survival (OS) (2-year OS, 84.5% vs 76.8%, P = .055) and recurrence-free survival (RFS) (2-year RFS, 73.9% vs 52.8%, P = .359). In the patients with pT4, OS (2-year OS, 79.4% vs 75.7%, P = .359) and RFS (2-year RFS, 71.3% vs 58.7%) were comparable. In the patients with pN2, OS (2-year OS, 83.4% vs 76.3%) and RFS (2-year RFS, 69.6% vs 36.2%) were also comparable.
CONCLUSIONS
LAP for pT4 and/or pN2 colon cancer showed comparable mid-term outcomes compared with OP. LAP was an acceptable surgical approach in this cohort.
目的
我们旨在评估腹腔镜手术（LAP）与开腹手术（OP）治疗病理性 T4（pT4）和/或 N2（pN2）结肠癌的中期结果。
方法
我们回顾性分析了 2015 年至 2020 年在六家医院进行的 255 例原发性肿瘤切除治疗 pT4 和/或 pN2 结肠癌患者，分为 LAP（n=204）和 OP 组（n=51）。为了最小化选择偏倚，对每组进行了倾向评分匹配，每组匹配了 47 例患者。
结果
在匹配之前，LAP 组的男性比例（53.9%比 37.3%，P=0.042）、左半结肠癌（53.9%比 37.3%，P=0.042）、D3 淋巴结清扫（90.7%比 68.6%，P < 0.001）和体质指数（kg/m）（22.3 比 21.8，P=0.039）明显更高。LAP 组 pT4b 的比例（7.8%比 40.4%，P < 0.001）较低，而 pN2 的比例较高（57.4%比 37.3%，P=0.012）。匹配后，两组的术前特征和病理状况相当。LAP 组和 OP 组的总生存（OS）（2 年 OS，84.5%比 76.8%，P=0.055）和无复发生存（RFS）（2 年 RFS，73.9%比 52.8%，P=0.359）相当。在 pT4 患者中，OS（2 年 OS，79.4%比 75.7%，P=0.359）和 RFS（2 年 RFS，71.3%比 58.7%）相当。在 pN2 患者中，OS（2 年 OS，83.4%比 76.3%）和 RFS（2 年 RFS，69.6%比 36.2%）也相当。
结论
LAP 治疗 pT4 和/或 pN2 结肠癌的中期结果与 OP 相当。在这一组中，LAP 是一种可以接受的手术方法。
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