Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Eur J Surg Oncol. 2024 Dec;50(12):108661. doi: 10.1016/j.ejso.2024.108661. Epub 2024 Sep 3.
The purpose of this study was to evaluate the association of MIS approaches for rectal cancer with long-term postoperative bowel dysfunction.
This was an Institutional Review Board-approved observational cohort study including consecutive patients with rectal or rectosigmoid cancer who underwent surgical resection between 2007 and 2017. The primary exposure was surgical approach, defined as open surgery or MIS (laparoscopy or robotic surgery). The primary outcome was major LARS, defined as a LARS score of ≥30. Subgroup analyses were performed by tumor height and type of MIS approach.
Among 749 potentially eligible patients, 514 (68.6 %) responded to the survey and were included for analysis. In total, 195 (37.9 %) patients underwent an MIS approach - 117 (60.0 %) laparoscopic and 78 (40.0 %) robotic. At a median follow-up of 6.1 (3.7-9.6) years from surgery, 222 patients (43.2 %) had major LARS (MIS: 41.0 % vs. open: 44.5 %, p = 0.44). On multivariable logistic regression, surgical approach had no association with major LARS (MIS, aOR: 1.21, 0.79-1.86). Older age (aOR: 1.03, 1.01-1.04), female sex (aOR: 1.75, 1.16-2.67), TME (aOR: 1.74, 1.01-3.02), diverting ileostomy (aOR: 2.74, 1.49-5.02) and radiation therapy (aOR: 2.63, 1.60-4.33) were all associated with major LARS. On subgroup analysis of patients with mid and low rectal cancers (n = 197), there remained no association between surgical approach and major LARS (MIS, aOR: 1.50, 0.68-3.33).
MIS approach to rectal cancer surgery was not associated with decreased risk of major LARS and should not be touted as a reason to offer MIS.
本研究旨在评估直肠癌微创（MIS）方法与长期术后肠功能障碍的相关性。
这是一项经机构审查委员会批准的观察性队列研究，纳入了 2007 年至 2017 年间接受手术切除的直肠或直肠乙状结肠癌患者。主要暴露因素为手术方式，定义为开放手术或 MIS（腹腔镜或机器人手术）。主要结局为主要 LARS，定义为 LARS 评分≥30 分。通过肿瘤高度和 MIS 方法类型进行亚组分析。
在 749 名潜在合格患者中，514 名（68.6%）对调查做出回应并纳入分析。共有 195 名（37.9%）患者接受了 MIS 方法治疗-117 名（60.0%）接受了腹腔镜手术，78 名（40.0%）接受了机器人手术。手术中位随访时间为 6.1（3.7-9.6）年后，222 名患者（43.2%）存在主要 LARS（MIS：41.0% vs. 开放：44.5%，p=0.44）。多变量逻辑回归显示，手术方式与主要 LARS 无关（MIS，aOR：1.21，0.79-1.86）。年龄较大（aOR：1.03，1.01-1.04）、女性（aOR：1.75，1.16-2.67）、全直肠系膜切除术（aOR：1.74，1.01-3.02）、预防性回肠造口术（aOR：2.74，1.49-5.02）和放疗（aOR：2.63，1.60-4.33）均与主要 LARS 相关。在中低位直肠癌患者的亚组分析（n=197）中，手术方式与主要 LARS 之间也无关联（MIS，aOR：1.50，0.68-3.33）。
直肠癌微创手术方式与降低主要 LARS 风险无关，不应将其作为推荐 MIS 的理由。
