Aoki Ryota, Maruyama Satoshi, Takii Yasumasa, Nogami Hitoshi
Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata, 9518566, Japan.
Surg Today. 2025 May;55(5):676-684. doi: 10.1007/s00595-024-02951-6. Epub 2024 Oct 29.
To evaluate the outcomes of laparoscopic resection of colorectal cancer in non-elite cases.
We defined patients whose clinical characteristics conformed to the criteria of the JCOG0404 trial as "elite" and those whose clinical characteristics did not conform to these criteria as "non-elite". Patients with Stage II/III colorectal cancer (n = 450) were analyzed. The elite (E) and non-elite (NE) groups were further divided into open (E-Open, NE-Open) and laparoscopic (E-Lap, NE-Lap) surgery groups. We compared the short- and long-term outcomes of these groups. Propensity score matching (PSM) was performed when comparing the NE groups.
The E group included 163 patients and the NE group included 287 patients. Before and after PSM, the NE-Lap group had significantly longer operative times, lower postoperative complication rates, earlier recovery of bowel function, and shorter postoperative hospital stays than the NE-Open group. After PSM, the Clavien-Dindo classification Grade ≥ III complications and reoperation rates in the NE-Lap group were significantly lower than those in the NE-Open group. The short-term outcomes of the NE-Lap group were comparable with those of the E-Lap group. The 5-year overall survival rates were not significantly different among the groups.
Laparoscopic resection of colorectal cancer is effective and safe, even in non-elite cases.
评估非精英病例中腹腔镜结直肠癌切除术的疗效。
我们将临床特征符合JCOG0404试验标准的患者定义为“精英”患者，将临床特征不符合这些标准的患者定义为“非精英”患者。对II/III期结直肠癌患者（n = 450）进行分析。精英（E）组和非精英（NE）组进一步分为开放手术（E-Open，NE-Open）组和腹腔镜手术（E-Lap，NE-Lap）组。我们比较了这些组的短期和长期疗效。在比较NE组时进行倾向评分匹配（PSM）。
E组包括163例患者，NE组包括287例患者。PSM前后，NE-Lap组的手术时间明显长于NE-Open组，术后并发症发生率更低，肠功能恢复更早，术后住院时间更短。PSM后，NE-Lap组的Clavien-Dindo分类≥III级并发症和再次手术率明显低于NE-Open组。NE-Lap组的短期疗效与E-Lap组相当。各组的5年总生存率无显著差异。
即使在非精英病例中，腹腔镜结直肠癌切除术也是有效且安全的。
