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[腹腔镜结直肠癌切除术——肿瘤学风险?]

[Laparoscopic resection of colorectal malignancy--an oncological risk?].

作者信息

Hohenberger W, Schneider C, Reymond M A, Scheidbach H, Köckerling F

机构信息

Chirurgische Klinik und Poliklinik, Universität Erlangen-Nürnberg.

出版信息

Zentralbl Chir. 1997;122(12):1127-33.

PMID:9499539
Abstract

Oncological risks associated with laparoscopic colorectal surgery in curative intention include inadequate radicality, seeding of tumour cells through unprotected recovery of the surgical specimen, faulty surgical technique, and failure to observe the technical and/or oncological limitations applicable to certain tumour sites. Results of laparoscopic colorectal surgery may be defined by pathohistologic findings (number of removed lymph nodes, count of tumor tears, clearance of margins) and long-term results (port-site metastases, local recurrence rate, number of distnant metastase, 5-year-survival). Current published results and first data from the Multicenter Study Group will be compared with the data of open surgery. Merely a few reports on the number of lymph nodes removed during such operations have been published. First data of the Multicenter Study Group Laparoscopis Colorectal Surgery seem to report comparable data to open surgery. There are no certain data the occurrence rate of portsite metastases as on long-term results, local recurrence rates and the 5-year-survival. So the sense and the quality of laparoscopic colorectal surgery in curative intention can't be judged nowadays. The many potential mistakes and hazards of oncological laparoscopic surgery make it mandatory that such interventions should be done only within the framework of prospective clinical studies covering limited indications.

摘要

根治性腹腔镜结直肠癌手术相关的肿瘤学风险包括根治性不足、手术标本无保护回收导致肿瘤细胞播散、手术技术失误以及未能遵守适用于某些肿瘤部位的技术和/或肿瘤学限制。腹腔镜结直肠癌手术的结果可通过病理组织学结果(切除淋巴结数量、肿瘤破裂数量、切缘清除情况)和长期结果(端口部位转移、局部复发率、远处转移数量、5年生存率)来定义。将当前已发表的结果和多中心研究组的首批数据与开放手术的数据进行比较。关于此类手术中切除淋巴结数量的报道仅有几篇。多中心研究组腹腔镜结直肠癌手术的首批数据似乎与开放手术的数据相当。关于端口部位转移的发生率、长期结果、局部复发率和5年生存率,尚无确切数据。因此,目前无法判断根治性腹腔镜结直肠癌手术的意义和质量。肿瘤学腹腔镜手术存在许多潜在的错误和风险,这使得此类干预必须仅在前瞻性临床研究的框架内进行,且研究的适应证有限。

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