Luck A, Hensman C, Hewett P
Division of Surgery, Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
Aust N Z J Surg. 1998 May;68(5):318-27. doi: 10.1111/j.1445-2197.1998.tb04763.x.
The success of laparoscopic cholecystectomy in providing patient benefits in the immediate postoperative period has led to laparoscopic techniques being used for many other intra-abdominal procedures. Colorectal resection for malignancy is one of the more contentious applications of this new technology, because the postoperative benefits are more subtle and the long-term onco logical results are as yet unknown.
A review of the English-language literature was undertaken in order to collate and analyse all published series where 20 or more laparoscopic colectomies were performed. and where the indication for resection in the majority of cases was adenocarcinoma of the colon.
Laparoscopic colectomy for cancer can be performed safely by experienced surgeons, although there is a considerable learning curve for the procedure. The expected benefits of minimal access surgery are provided by laparoscopic colectomy, although to a lesser extent than that seen with other procedures. The oncological safety of the procedure is as yet unproven. It is clear that an equivalent resection can be performed, but not whether this translates to an equivalent recurrence and survival rate. Reports of isolated port site recurrences are of concern.
Early results of laparoscopic colectomy for cancer are encouraging, although the fate of this procedure rests with the analysis of the large multicentre prospective randomized trials currently under way, particularly with regard to the long-term recurrence and survival rates.
腹腔镜胆囊切除术在术后短期内给患者带来了益处，这使得腹腔镜技术被应用于许多其他腹部手术。结直肠癌切除术是这项新技术较具争议的应用之一，因为术后益处较为细微，且长期肿瘤学结果尚不清楚。
对英文文献进行综述，以整理和分析所有已发表的系列研究，这些研究中进行了20例或更多例腹腔镜结肠切除术，且大多数病例的切除指征为结肠癌。
经验丰富的外科医生能够安全地实施腹腔镜结肠癌切除术，尽管该手术存在相当大的学习曲线。腹腔镜结肠切除术能带来微创手术预期的益处，尽管程度低于其他手术。该手术的肿瘤学安全性尚未得到证实。显然可以进行等效的切除，但这是否能转化为等效的复发率和生存率尚不清楚。孤立的切口部位复发报告令人担忧。
腹腔镜结肠癌切除术的早期结果令人鼓舞，不过该手术的命运取决于目前正在进行的大型多中心前瞻性随机试验的分析结果，尤其是长期复发率和生存率方面的结果。
