Köckerling F, Reymond M A, Schneider C, Wittekind C, Scheidbach H, Konradt J, Köhler L, Bärlehner E, Kuthe A, Bruch H P, Hohenberger W
Department of Surgery, University of Erlangen, Germany.
Dis Colon Rectum. 1998 Aug;41(8):963-70. doi: 10.1007/BF02237381.
Laparoscopic colorectal surgery for cancer is currently under discussion. Results of large, randomized studies will not be available for a number of years yet. This study analyses the results of such resections in consecutive patients operated on by unselected surgeons.
A prospective, observational, multicenter study was initiated on August 1, 1995, in the German-speaking countries of Europe. One year after initiation of the study, findings are presented with respect to the quality of oncologic resections.
Of 500 operations, 231 (46 percent) were performed for cancer, 167 (33 percent) with a curative intent. The most common curative resections were as follows: 63 anterior rectum resections (38 percent), 51 sigmoid resections (30 percent), and 27 abdominoperineal resections (16 percent). Segmental resections were performed in 20 patients (12 percent). Intraoperative tumor spillage was reported in 2 percent. Mean number of lymph nodes harvested was 13 (confidence interval, 5-95 percent; range, 11.5-14.6) and positive lymph nodes harvested was 2.2 (confidence interval, 5-95 percent; range, 0.9-3.4). Significant differences were noted between participating centers in terms of number of lymph nodes resected (P < 0.0001). Distal and proximal resection margins were tumor-free in every case. Lateral margins were tumor free when examined. In the case of 63 curative anterior resections, the mean distal resection margin was 39 (confidence interval, 5-95 percent; range, 33-45) mm, and in 8 of these resections, it was less than 20 min. Mean blood loss was 344 (confidence interval, 5-95 percent; 292-396) ml, and 21 percent of patients received blood transfusion.
These data document that the average quality of laparoscopic colorectal procedures for cancer is satisfactory but differs among surgeons.
目前正在讨论腹腔镜结直肠癌手术。大型随机研究的结果在数年内都无法获得。本研究分析了由未经挑选的外科医生为连续患者进行此类切除手术的结果。
1995年8月1日在欧洲讲德语的国家启动了一项前瞻性、观察性、多中心研究。研究开始一年后，报告了肿瘤切除质量方面的研究结果。
在500例手术中，231例（46%）是因癌症进行的手术，167例（33%）有治愈意图。最常见的根治性切除如下：63例直肠前切除术（38%），51例乙状结肠切除术（30%），27例腹会阴联合切除术（16%）。20例患者（12%）进行了节段性切除。报告术中肿瘤溢出的占2%。平均采集淋巴结数为13个（置信区间，5 - 95%；范围，11.5 - 14.6），采集到的阳性淋巴结数为2.2个（置信区间，5 - 95%；范围，0.9 - 3.4）。各参与中心在切除淋巴结数量方面存在显著差异（P < 0.0001）。每个病例的远、近端切缘均无肿瘤。检查时外侧切缘无肿瘤。在63例根治性前切除术中，平均远端切缘为39毫米（置信区间，5 - 95%；范围，33 - 45），其中8例切缘小于20毫米。平均失血量为344毫升（置信区间，5 - 95%；292 - 396），21%的患者接受了输血。
这些数据表明，腹腔镜结直肠癌手术的平均质量令人满意，但不同外科医生之间存在差异。
