Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study
Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study
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腹腔镜与开腹手术治疗腹膜外直肠癌：一项前瞻性比较研究
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
C. Garrone
中科院分区：
文献类型：
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作者：
M. Morino;M. Allaix;G. Giraudo;F. Corno;C. Garrone
背景腹腔镜直肠癌切除术（LR）在腹膜外直肠癌治疗中的作用尚不清楚。本研究的目的是比较围手术期和长期的结果腹腔镜和开放切除术（OR）为低，中直肠cancer.MethodsA前瞻性非随机试验比较患者提交的OR或LR为低，中直肠cancer在一个单一的institutionalwas.ResultsThe研究包括191例连续：98例患者谁接受LR和93谁接受OR。平均随访期为46.3个月，LR和OR为49.7个月。LR的转化率为18.4%。使用LR后，患者完全活动的平均时间更短（1.7 vs 3.3天; p < 0.001），排气（2.6 vs 3.9天; p < 0.001）和排便（3.8 vs 4.7天; p < 0.01）以及恢复口服摄入（3.4 vs 4.8天; p < 0.001）的时间更早。LR的平均住院时间较短，但差异未达到显著性（11.4 vs 13天）。发病率和死亡率相似：LR（24.4%和1%）和OR（23.6%和2.2%）。腹腔镜患者的吻合口瘘（13.5% vs 5.1%）和再次手术（6.1% vs 3.2%）发生率较高，但差异无统计学意义。腹腔镜切除术的局部复发率显著降低（3.2% vs 12.6%; p < 0.05）。LR后5年的累积生存率和无病率分别为80%和65.4%，OR后分别为68.9%和58.9%（无显著差异）。分期比较显示，LR中III期和IV期癌症的累积生存期延长，（分别为82.5% vs 40.5%; p = 0.006和15.8% vs 0%; p = 0.013）和LR中III期癌症相关死亡率降低（11.4%vs51.9%，p = 0.001）.结论与传统的开放手术相比，LR治疗低位和中段直肠癌的特点是恢复更快，总体发病率相似（但吻合口瘘发生率更高），并且没有任何不良的肿瘤学影响。
BackgroundThe role of laparoscopic resection (LR) in the management of extraperitoneal rectal cancer still is unclear. This study aimed to compare perioperative and long-term results of laparoscopic and open resection (OR) for low and midrectal cancer.MethodsA prospective nonrandomized trial comparing patients submitted to OR or LR for low and midrectal cancer at a single institution was conducted.ResultsThe study included 191 consecutive patients: 98 patients who underwent LR and 93 who underwent OR. The mean follow-up period was 46.3 months for LR and 49.7 months for OR. The conversion rate for LR was 18.4%. With the use of LR, the mean time for complete patient mobilization was shorter (1.7 vs 3.3 days; p < 0.001) and patients were earlier in passing flatus (2.6 vs 3.9 days; p < 0.001) and stools (3.8 vs 4.7 days; p < 0.01), and in resuming oral intake (3.4 vs 4.8 days; p < 0.001). The mean hospital stay was shorter for LR, but the difference did not reach significance (11.4 vs 13 days). Morbidity and mortality rates were similar: LR (24.4% and 1%) and OR (23.6% and 2.2%). Laparoscopic patients presented a higher rate of anastomotic fistulas (13.5% vs 5.1%) and reoperations (6.1% vs 3.2%) but the difference was statistically nonsignificant. Laparoscopic resection presented a significantly lower local recurrence rate (3.2% vs 12.6%; p < 0.05). The cumulative survival and disease-free rates at 5 years were, respectively, 80% and 65.4% after LR and 68.9% and 58.9% after OR (nonsignificant difference). Stage-by-stage comparison showed prolonged cumulative survival for stages III and IV cancer in LR (82.5% vs 40.5%; p = 0.006 and 15.8% vs 0%; p = 0.013, respectively) and a reduced rate of cancer-related death for stage III in LR (11.4% vs 51.9%; p = 0.001).ConclusionsAs compared with conventional open surgery, LR for low and midrectal cancer is characterized by a faster recovery and similar overall morbidity (but a higher rate of anastomotic leakages), and does not present any adverse oncologic effect.
影响因子：
120.7
作者：
Weeks, JC;Nelson, H;Schroeder, G
通讯作者：
Schroeder, G