Short- and medium-term results of totally laparoscopic resection for colorectal liver metastases
Short- and medium-term results of totally laparoscopic resection for colorectal liver metastases
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DOI：
10.1002/bjs.7034
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发表时间：
2010-06-01
影响因子：
9.6
通讯作者：
Pearce, N.
中科院分区：
文献类型：
--
作者：
Abu Hilal, M.;Underwood, T.;Pearce, N.
背景：腹腔镜手术治疗原发性结直肠癌已经很普遍，但腹腔镜手术治疗结直肠癌肝转移（CRLM）的进展缓慢，主要是由于对安全性、可行性和肿瘤学效率的质疑。方法：回顾性分析2004 - 2009年所有CRLM患者的前瞻性资料。数据库分析手术细节、住院时间、术后结果和中期生存率。结果：5年内，135例CRLM患者接受了肝脏手术。腹腔镜手术中位手术时间为220分钟，中位失血量为363 ml；平均无瘤切除边缘为17.0 mm(76%大于1 cm)，未观察到肝口转移或手术部位复发。6例患者的手术转为开放手术（2例因出血）。腹腔镜组的总生存率接近90%，中位随访时间为22个月。结论：本系列全腹腔镜CRLM切除术在死亡率、发病率、切除范围、局部复发或转移、生存率等方面均有良好的中短期效果。与同期的开放经验相比，在高度选择的连续系列中，腹腔镜入路是安全有效的。
Background: Laparoscopic surgery for primary colorectal cancer is now commonplace but the uptake of laparoscopic surgery for colorectal liver metastasis (CRLM) has been slow, mainly owing to doubts regarding safety, feasibility and oncological efficiency.Methods: Prospectively collected data of all patients treated for CRLM between 2004 and 2009 were reviewed retrospectively. The database was analysed for operative details, hospital stay, postoperative results and medium-term survival.Results: Over 5 years, 135 patients underwent liver surgery for CRLM. For laparoscopic procedures, the median duration of operation was 220 min and median blood loss was 363 ml; a mean tumour-free resection margin of 17.0 mm was achieved (more than 1 cm in 76 per cent), and no port-site metastasis or surgical-site recurrence was observed. The procedure was converted to open surgery in six patients (two for bleeding). Overall survival for the laparoscopic group approached 90 per cent with median follow-up of 22 months.Conclusion: In this series totally laparoscopic CRLM resection had good short- and medium-term results in terms of mortality, morbidity, resection margins, local recurrence or port-site metastasis, and survival. Compared with contemporaneous open experience, the laparoscopic approach was safe and effective in a highly selected consecutive series.