Tamura Koji, Fujimoto Takaaki, Shimizu Toru, Nagayoshi Kinuko, Mizuuchi Yusuke, Hisano Kyoko, Horioka Kohei, Shindo Koji, Nakata Kohei, Ohuchida Kenoki, Nakamura Masafumi
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
Surg Endosc. 2024 Dec;38(12):7139-7151. doi: 10.1007/s00464-024-11310-y. Epub 2024 Sep 30.
Patients with a history of colorectal cancer (CRC) are at increased risk of developing secondary synchronous/metachronous CRCs. The role of minimally invasive surgery (MIS) for multiple CRCs remains unclear. This study aimed to evaluate the short-term outcomes of MIS in patients with multiple CRCs and elucidate their clinical characteristics.
This retrospective study reviewed CRC patients who underwent MIS between 2010 and 2023. Multiple CRC cases were categorized into synchronous and metachronous cohorts. Demographics, pathological findings, and perioperative outcomes were analyzed. Propensity score matching (PSM) analysis was performed as appropriate.
A total of 1,272 patients met the inclusion criteria, with 99 (7.8%) having multiple CRCs (75 synchronous and 24 metachronous). Multiple CRC patients had a higher prevalence of strong family history (8.1% vs. 1.0%, P < 0.001) and right-sided colon cancer (55.6% vs. 34.4%, P < 0.001) compared to solitary CRC patients. MSI-high/MMR-deficient status, including Lynch syndrome, was frequently observed among patients with multiple CRCs. Synchronous CRCs requiring double-anastomosis were associated with longer operation times (P = 0.03) and increased blood loss (P = 0.03) compared to those with a single-anastomosis. In the metachronous cohort, repeat operation patterns were categorized based on tumor location and sacrificed arteries. Preservation of the left-colic artery avoided extended colectomy in some patients. Patients with multiple CRC involving rectal cancer had a higher anastomotic leakage (AL) rate (17.6% vs. 5.7%, P < 0.01); however, this difference in AL rate disappeared after PSM (8.8% vs. 8.8%, P = 1.0). In patients with multiple CRCs, AL has not been observed ever since the indocyanine green fluorescence imaging was implemented.
MIS is feasible for multiple CRCs, with perioperative outcomes comparable to those for solitary CRCs. Preservation of critical arteries may benefit patients at high risk of secondary CRCs, particularly those with a strong family history of CRC, right-sided tumors, or MSI-high/MMR-deficient profiles, including Lynch syndrome.
有结直肠癌（CRC）病史的患者发生继发性同时性/异时性结直肠癌的风险增加。微创手术（MIS）在多发性结直肠癌中的作用仍不明确。本研究旨在评估MIS治疗多发性结直肠癌患者的短期结局，并阐明其临床特征。
本回顾性研究对2010年至2023年间接受MIS治疗的CRC患者进行了分析。多发性CRC病例分为同时性和异时性队列。分析了人口统计学、病理结果和围手术期结局。并酌情进行倾向评分匹配（PSM）分析。
共有1272例患者符合纳入标准，其中99例（7.8%）患有多发性CRC（75例同时性和24例异时性）。与单发CRC患者相比，多发性CRC患者有家族史（8.1%对1.0%，P<0.001）和右半结肠癌（55.6%对34.4%，P<0.001）的患病率更高。在多发性CRC患者中经常观察到微卫星高度不稳定/错配修复缺陷状态，包括林奇综合征。与单吻合的同时性CRC相比，需要双吻合的同时性CRC手术时间更长（P=0.03），失血量增加（P=0.03）。在异时性队列中，根据肿瘤位置和牺牲的动脉对再次手术模式进行分类。保留左结肠动脉可避免部分患者进行扩大结肠切除术。累及直肠癌的多发性CRC患者吻合口漏（AL）率更高（17.6%对5.7%，P<0.01）；然而，PSM后AL率的差异消失（8.8%对8.8%，P=1.0）。在多发性CRC患者中，自实施吲哚菁绿荧光成像以来未观察到AL。
MIS治疗多发性CRC是可行的，围手术期结局与单发CRC相当。保留关键动脉可能使继发性CRC高危患者受益，特别是那些有CRC家族史、右侧肿瘤或微卫星高度不稳定/错配修复缺陷特征（包括林奇综合征）的患者。
