Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch.
College of Medicine, Chang Gung University.
Int J Surg. 2024 Aug 1;110(8):4598-4607. doi: 10.1097/JS9.0000000000001536.
Insufficient evidence exists to ascertain the long-term prognosis in patients with obesity undergoing laparoscopic surgery versus open surgery for colorectal cancer.
Employing an institutional database from 2009 to 2019, we assessed individuals with a BMI of greater than or equal to 30 kg/m 2 who underwent surgery for primary stage I-III colorectal adenocarcinoma. The authors used propensity score-weighted analysis to compare short-term and oncologic outcomes between laparoscopic and open surgical approaches.
This study enrolled 473 patients (open vs. laparoscopic surgery: 220 vs. 253; median follow-up period, 60 months). The laparoscopy group showed a significantly longer operative time (252 vs. 212 min), a higher anastomotic-leakage rate (5.14% vs. 0.91%), and a greater proportion of Clavien-Dindo class greater than III complications (5.93% vs. 1.82%). The open group showed a higher wound infection rate (7.27% vs. 3.16%) and a higher readmission rate (6.36% vs. 2.37%). After propensity score weighting, laparoscopy was inferior to open surgery in terms of long-term overall survival (hazard ratio: 1.43), disease-free survival (1.39), and recurrence rate (21.1% vs. 14.5%). In the subgroup analysis, female patients, older individuals, stage III patients, patients with rectal cancer, and those who underwent surgery after 2014 showed inferior long-term outcomes after laparoscopy.
Laparoscopic colorectal cancer surgery for patients with obesity requires significant caution. Despite good short-term outcomes, this procedure is associated with hidden risks and poor long-term prognoses. In female patients, older individuals, stage III patients, patients with rectal cancer, and those treated in the late surgery era subgroups, caution is advised when performing laparoscopic surgery.
对于肥胖患者接受腹腔镜手术与开腹手术治疗结直肠癌的长期预后，目前仍缺乏足够的证据。
利用 2009 年至 2019 年的机构数据库，我们评估了 BMI 大于或等于 30kg/m2 且接受原发性 I-III 期结直肠腺癌手术的个体。作者使用倾向评分加权分析比较了腹腔镜与开腹手术方法的短期和肿瘤学结果。
这项研究纳入了 473 名患者（开腹手术组 vs. 腹腔镜手术组：220 例 vs. 253 例；中位随访时间为 60 个月）。腹腔镜组的手术时间明显更长（252 分钟 vs. 212 分钟），吻合口漏的发生率更高（5.14% vs. 0.91%），Clavien-Dindo 分级大于 III 级并发症的比例更大（5.93% vs. 1.82%）。开腹组的切口感染率更高（7.27% vs. 3.16%）和再入院率更高（6.36% vs. 2.37%）。在进行倾向评分加权后，腹腔镜手术在长期总体生存率（风险比：1.43）、无病生存率（1.39）和复发率（21.1% vs. 14.5%）方面均劣于开腹手术。在亚组分析中，女性患者、年龄较大的患者、III 期患者、直肠癌患者以及在 2014 年后接受手术的患者，腹腔镜手术后的长期结局较差。
肥胖患者的腹腔镜结直肠癌手术需要慎重考虑。尽管短期结果良好，但该手术存在潜在风险，且长期预后较差。在女性患者、年龄较大的患者、III 期患者、直肠癌患者和手术晚期治疗亚组中，进行腹腔镜手术时应谨慎。
