Laparoscopic Ultra Low Anterior Resection: Single Center, 6-Year Study
Laparoscopic Ultra Low Anterior Resection: Single Center, 6-Year Study
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DOI：
10.1089/lap.2019.0652
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发表时间：
2020-01-23
影响因子：
1.3
通讯作者：
Jayakumar, K. J.
中科院分区：
文献类型：
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作者：
Sankaran, Rajkumar Janavikula;Raman, Dharmendra Kollapalayam;Jayakumar, K. J.
背景：这项研究是对在一家腹腔镜手术中心进行的一系列腹腔镜超低位前切除术(ULAR)的前瞻性分析，以评估手术结果、肿瘤疗效和术后生活质量。方法：对43例T3N1M0期极低位直肠癌患者，年龄40~68岁，年龄40~68岁，均行正电子发射计算机断层扫描和盆腔核磁共振检查，行新辅助放化疗(NCRT)后行腹腔镜下ULAR和回肠造口术。结果：43例患者中3例(7%)发生放射性漏(A级)，总的并发症发生率为9.3%，但仅1例(2.3%)患者因继发出血需要局部冲洗和再次缝合。复发2/43例(4.7%)，其中1例中转腹会切除术。另一名患者有远处转移，并拒绝进一步治疗。41例(95.3%)患者通过低位前切除术综合征(LARS)评分评估其功能结果，仅7.3%的患者在1~6年的随访期内有较大的LARS评分，生活质量良好。结论：nCRT联合腹腔镜下ULAR治疗极低位直肠癌是一种可行的治疗方案，具有术后并发症少、局部复发率低、LARS发生率低等优点。
Background: This study represents a prospective analysis of a series of laparoscopic ultra low anterior resection (ULAR) done at a laparoscopic surgical center to assess the surgical outcome, oncological efficacy, and quality of life after surgery. Methods: Over a period of 6 years (2013-2018), 43 patients aged between 40 and 68 years, with very low rectal cancers (3-6 cm from the anal verge), within T3N1M0 stage, assessed by positron emission tomography-computed tomography and pelvic magnetic resonance imaging, underwent neoadjuvant chemoradiotherapy (nCRT) followed by laparoscopic ULAR and simultaneous diversion ileostomy. Results: The overall complication rate was low and there was an overall leak rate of 9.3% with a radiological leak (Grade A) in 3 of the 43 patients (7%), but only 1 (2.3%) patient required a local lavage and a resuturing for secondary hemorrhage. Recurrence was seen in 2/43 (4.7%), one of whom had a conversion to abdominoperineal resection. The other had distant metastasis and refused further treatment. The functional outcome is assessed in 41 (95.3%) patients by low anterior resection syndrome (LARS) score and a reasonable quality of life with major LARS was seen in only 7.3% of the patients at a follow-up ranging from 1 to 6 years. Conclusion: The nCRT followed by laparoscopic ULAR is a feasible option for operable very low rectal cancers and is associated with minimal postoperative events, a low local recurrence and less incidence of LARS.