Colorectal Surgery Department, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Egypt. Electronic address: https://twitter.com/dr_samehhany81.
Colorectal Surgery Department, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel. Electronic address: https://twitter.com/nirhoresh.
Surgery. 2024 Jul;176(1):60-68. doi: 10.1016/j.surg.2024.02.028. Epub 2024 Apr 10.
Colon cancer prognosis is primarily dependent on the stage at diagnosis, but tumor size and location may also impact prognosis. This study aimed to assess the characteristics and outcomes of patients with ≥5 cm colonic adenocarcinomas and compare outcomes of open and minimally invasive surgery for stage I to III large colonic adenocarcinomas.
The National Cancer Database (2010-2019) was searched for patients with colonic adenocarcinomas ≥5 cm. Outcomes of patients who underwent minimally invasive surgery or open surgery were compared after propensity-score matching. The primary outcome was 5-year overall survival and, secondarily, hospital stay, surgical margins, and short-term mortality.
A total of 126,959 patients were included (22.1% of all diagnosed adenocarcinomas). 56% of tumors were right-sided, 32.6% were left-sided, and 11.4% were in the transverse colon. Stage IV disease was recorded in 34.6% of patients. Lymphovascular invasion, perineural invasion, and Kirsten rat sarcoma viral oncogene homolog mutations were recorded in 35.7%, 14.9%, and 41.6% of patients. The rate of positive surgical margins was 9.8%. Median hospital stay was 6 (interquartile range: 4-8) days. 30- and 90-day mortality rates were 4.1% and 7.5%, respectively. After matching, 15,228 patients in the open surgery group were matched to a similar number in the minimally invasive surgery group. The minimally invasive surgery group was associated with significantly lower rates of 30- and 90-day mortality, positive surgical margins, shorter hospital stay, and longer median overall survival (110.6 vs 86.6 months, P < .001) than did open surgery.
Large colonic adenocarcinomas are mostly right-sided or transverse and present at a more advanced stage with adverse pathologic features. Minimally invasive surgery was associated with better overall survival and short-term benefits when compared with open surgery.
结肠癌的预后主要取决于诊断时的分期，但肿瘤大小和位置也可能影响预后。本研究旨在评估≥5cm 结直肠腺癌患者的特征和结局，并比较Ⅰ期至Ⅲ期大型结直肠腺癌行微创和开放手术的结局。
从国家癌症数据库（2010-2019 年）中检索直径≥5cm 的结直肠腺癌患者。对倾向评分匹配后的微创和开放手术患者的结局进行比较。主要结局为 5 年总生存率，次要结局为住院时间、手术切缘和短期死亡率。
共纳入 126959 例患者（所有诊断腺癌的 22.1%）。56%的肿瘤位于右侧，32.6%位于左侧，11.4%位于横结肠。记录到 34.6%的患者有Ⅳ期疾病。35.7%的患者有淋巴血管侵犯，14.9%的患者有神经周围侵犯，41.6%的患者有 Kirsten 大鼠肉瘤病毒致癌基因同源物突变。切缘阳性率为 9.8%。中位住院时间为 6 天（四分位距：4-8 天）。30 天和 90 天死亡率分别为 4.1%和 7.5%。匹配后，开放手术组有 15228 例患者与微创组有相似数量的患者相匹配。微创组的 30 天和 90 天死亡率、切缘阳性率、住院时间较短和中位总生存期较长（110.6 比 86.6 个月，P<0.001）。
大型结直肠腺癌多位于右侧或横结肠，且处于更晚期，具有不良的病理特征。与开放手术相比，微创手术与更好的总生存率和短期获益相关。
