Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan.
Int J Colorectal Dis. 2023 May 27;38(1):145. doi: 10.1007/s00384-023-04439-0.
Reports of redo laparoscopic colorectal resection (Re-LCRR) are scarce. In order to evaluate the safety and short-term outcomes of Re-LCRR, we performed a matched case-control analysis of patients who underwent this procedure for colorectal cancer.
This was a retrospective, monocentric study that included patients who underwent Re-LCRR for colorectal cancer between January 2011 and December 2019 at our institution. The patients were compared to a 2:1 matched sample. Matching was conducted based on age, sex, BMI, surgical procedure, and clinical stage.
Twenty-nine patients underwent Re-LCRR (RCRR group) and were compared to 58 patients selected by matching who underwent LCRR as primary resection (PCRR group). The median of age of the 29 patients of RCRR group was 75 (IQR 56-81) years and the RCRR group included 14 males. The median operative time of the RCRR group was 167 (IQR 126-232) minutes, and the median intraoperative blood loss was 5 (IQR 2-35) ml. In the RCRR group, there were no cases that required conversion to laparotomy. The short-term outcomes of the two groups did not differ to a statistical extent with respect to operative time (p = 0.415), intraoperative blood loss (p = 0.971), rate of conversion to laparotomy (p = 0.477), comorbidity (p = 0.215), and postoperative hospital stay (p = 0.809). No patients in either group experienced postoperative anastomotic leakage or required re-operation due to postoperative complications, and there was no procedure-related death. However, in terms of oncological factors, although there was no difference in the number of cases with a positive radical margin between the two groups (p = 1.000), the number of harvested lymph nodes in the RCRR group was significantly lower than that in the PCRR group (p = 0.015) and the RCRR group included 10 cases with less than 12 harvested lymph nodes.
Re-LCRR is associated with good short-term results and can be safely performed; however, the number of harvested lymph nodes is significantly reduced in comparison to primary resection cases, and further studies are needed to evaluate its long-term prognosis.
redo 腹腔镜结直肠切除术（Re-LCRR）的报道很少。为了评估 Re-LCRR 的安全性和短期结果，我们对在我院接受该手术治疗结直肠癌的患者进行了匹配病例对照分析。
这是一项回顾性、单中心研究，纳入 2011 年 1 月至 2019 年 12 月期间在我院接受 Re-LCRR 治疗的结直肠癌患者。将这些患者与 2:1 匹配的样本进行比较。匹配是基于年龄、性别、BMI、手术方式和临床分期进行的。
29 例患者接受 Re-LCRR（RCRR 组），并与 58 例接受初次切除的 LCRR 患者（PCRR 组）进行匹配。RCRR 组 29 例患者的中位年龄为 75 岁（IQR 56-81），RCRR 组中包括 14 名男性。RCRR 组的中位手术时间为 167 分钟（IQR 126-232），术中出血量为 5 毫升（IQR 2-35）。RCRR 组无中转开腹的病例。两组的短期结局在手术时间（p=0.415）、术中出血量（p=0.971）、中转开腹率（p=0.477）、合并症（p=0.215）和术后住院时间（p=0.809）方面均无统计学差异。两组均无患者发生术后吻合口漏或因术后并发症需要再次手术，也无手术相关死亡。然而，在肿瘤学因素方面，两组阳性切缘的病例数虽无差异（p=1.000），但 RCRR 组的淋巴结清扫总数明显低于 PCRR 组（p=0.015），且 RCRR 组有 10 例淋巴结清扫数少于 12 枚。
Re-LCRR 短期结果良好，且安全可行；然而，与初次切除病例相比，淋巴结清扫总数明显减少，需要进一步研究评估其长期预后。
