Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Division of Colon and Rectal Surgery, New Taipei Municipal TuCheng Hospital, No. 6, Sec. 2, Jincheng Rd., Tucheng Dist, New Taipei City, 236043, Taiwan (R.O.C.).
Langenbecks Arch Surg. 2024 Aug 13;409(1):250. doi: 10.1007/s00423-024-03440-7.
Although minimally invasive colorectal surgery has been proven to have a shorter hospital stay and fewer short-term complications than open surgery, the advantages of laparoscopic surgery for colorectal cancer patients undergoing hemodialysis have not been validated. This study compared the outcomes of open and laparoscopic approaches in these patients.
Between January 2007 and December 2020, we retrospectively analyzed the clinical data of 78 hemodialysis patients who underwent curative-intent, elective colorectal surgery. Patients were divided into two groups according to the surgical method: open and laparoscopic.
Postoperative morbidity (p = 0.480) and mortality (p = 0.598) rates and length of hospital stay (28.8 vs. 27.5 days, p = 0.830) were similar between the groups. However, laparoscopic surgery patients had a shorter return to clear liquid, full liquid, or soft food time than open surgery patients (p < 0.001, p = 0.007, and p = 0.002, respectively). Disease-free survival and long-term cancer-specific survival rates were also similar between the two groups (p = 0.353 and p = 0.201, respectively). Multivariate analysis revealed that intraoperative blood transfusion was a risk factor for severe complications and mortality (OR 6.055; p = 0.046), and the odds ratio (OR) of laparoscopic surgery was not significantly greater than that of open surgery (OR = 0.537, p = 0.337).
Although laparoscopic surgery did not result in hemodialysis patients having a shorter postoperative hospital stay, our results suggest that the laparoscopic approach is as safe as open surgery for hemodialysis patients and may be beneficial for shortening the return time to food intake.
虽然微创结直肠手术已被证明比开放手术具有更短的住院时间和更少的短期并发症，但腹腔镜手术在接受血液透析的结直肠癌患者中的优势尚未得到验证。本研究比较了这些患者的开放手术和腹腔镜手术的结果。
2007 年 1 月至 2020 年 12 月，我们回顾性分析了 78 例接受根治性、择期结直肠手术的血液透析患者的临床资料。根据手术方法将患者分为两组：开放组和腹腔镜组。
两组患者术后发病率（p=0.480）和死亡率（p=0.598）以及住院时间（28.8 天比 27.5 天，p=0.830）相似。然而，腹腔镜手术患者在恢复清液、全液或软食方面的时间短于开放手术患者（p<0.001、p=0.007 和 p=0.002）。两组患者无病生存率和长期癌症特异性生存率也相似（p=0.353 和 p=0.201）。多因素分析显示，术中输血是严重并发症和死亡率的危险因素（OR 6.055；p=0.046），腹腔镜手术的优势比（OR）并不显著大于开放手术（OR=0.537，p=0.337）。
尽管腹腔镜手术并未使血液透析患者的术后住院时间缩短，但我们的结果表明，腹腔镜手术与开放手术一样安全，并且可能有利于缩短恢复进食的时间。
