Lord S A, Larach S W, Ferrara A, Williamson P R, Lago C P, Lube M W
Colon and Rectal Clinic of Orlando, Florida 32806, USA.
Dis Colon Rectum. 1996 Feb;39(2):148-54. doi: 10.1007/BF02068068.
Laparoscopic resection for carcinoma of the colon and rectum is currently under intense scrutiny.
The purpose of this study is to review our three-year experience of laparoscopic surgery for colon and rectal carcinoma.
From October 1991 to September 1994, 76 laparoscopic procedures were performed for colorectal neoplasia (32 males and 44 females; mean age, 69 years). Fifty-five procedures were done for carcinoma, 16 for large polyps, and five for diversion in patients with unresectable cancer. For resectable tumors, the average size was 4 cm; staging was as follows: Dukes A, 10 patients; Dukes B1, 11; Dukes B2, 18; Dukes C1, 1; Dukes C2, 9; and Dukes D, 8. Fourteen cases (25 percent) that were converted to open procedures were compared with the 41 cases that were completed laparoscopically for differences in tumor size, surgical margins, number of lymph nodes harvested, length of hospital stay, and evidence of recurrence. Procedures completed laparoscopically were then compared with a group of open controls completed during the same time period.
During the first six months, the conversion rate was 32 percent but dropped to 8 percent in the last six months. There were a total of 19 complications (25 percent), of which 8 (14 percent) were directly related to the laparoscopic technique. The mean number of lymph nodes harvested in laparoscopic resection for carcinoma was 8.5, and the average closest tumor margin was 4.5 cm. When laparoscopic resections were compared with converted and standard open colectomies, there was no significant difference in tumor margins or numbers of nodes resected. Length of stay was significantly shorter for anterior resections completed laparoscopically than for converted or conventional colectomies. Although this was also the trend for right hemicolectomies, it did not reach statistical significance. Mean follow-up of the group completed laparoscopically was 16.7 months, during which there was one recurrence. There were no trocar site recurrences.
This early experience seems to indicate that laparoscopic surgery for colorectal carcinoma does not per se compromise surgical oncologic principles and encourages us to continue our critical appraisal of this technique.
目前，腹腔镜下结肠直肠癌切除术正受到密切关注。
本研究旨在回顾我们三年来腹腔镜下结肠直肠癌手术的经验。
1991年10月至1994年9月，对76例结直肠肿瘤患者进行了腹腔镜手术（男性32例，女性44例；平均年龄69岁）。其中55例为癌症手术，16例为大息肉手术，5例为不可切除癌症患者的改道术。对于可切除肿瘤，平均大小为4厘米；分期如下：Dukes A期10例；Dukes B1期11例；Dukes B2期18例；Dukes C1期1例；Dukes C2期9例；Dukes D期8例。将14例（25%）中转开腹手术的病例与41例腹腔镜完成手术的病例在肿瘤大小、手术切缘、清扫淋巴结数量、住院时间和复发证据方面进行比较。然后将腹腔镜完成手术的病例与同期完成的一组开放手术对照病例进行比较。
前六个月中转率为32%，但后六个月降至8%。共有19例并发症（25%），其中8例（14%）与腹腔镜技术直接相关。腹腔镜下癌症切除术清扫淋巴结的平均数量为8.5个，最接近肿瘤的平均切缘为4.5厘米。将腹腔镜切除术与中转开腹手术及标准开放结肠切除术比较，肿瘤切缘和切除淋巴结数量无显著差异。腹腔镜完成的前切除术住院时间明显短于中转开腹手术或传统结肠切除术。虽然右半结肠切除术也有这种趋势，但未达到统计学意义。腹腔镜完成手术组的平均随访时间为16.7个月，期间有1例复发。无套管针穿刺部位复发。
这一早期经验似乎表明，腹腔镜下结肠直肠癌手术本身并不违背外科肿瘤学原则，并鼓励我们继续对该技术进行严格评估。
