Right versus left laparoscopic colectomy for colon cancer: does side make any difference?
Right versus left laparoscopic colectomy for colon cancer: does side make any difference?
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DOI：
10.1007/s00384-017-2776-x
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发表时间：
2017-06-01
影响因子：
2.8
通讯作者：
Vaccaro, Carlos A.
中科院分区：
文献类型：
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作者：
Campana, Juan P.;Pellegrini, Pablo A.;Vaccaro, Carlos A.
目的比较右腹腔镜结肠切除术（RLC）和左腹腔镜结肠切除术（LLC）治疗结肠癌的术中、术后疗效。2004年1月至2014年12月期间因结肠癌接受选择性RLC或LLC治疗的患者被确定并入选回顾性分析。主要结局是技术难度（包括手术时间、术中并发症和转换率）和术后结局（包括术后并发症、住院时间、再干预、再入院和死亡率）。共分析547例患者，平均年龄68.5岁，男性48.4%。RLC组的平均年龄（71比65，p < 0.001）、ASA 3/4级（36比26%，p = 0.02）和合并率（61比48%，p = 0.003）更高。在技术难度方面，两组术中并发症（4.1 vs 5.9%, p = 0.34）和转换率（6.2 vs 3.9%, p = 0.24）无差异。RLC的平均手术时间显著缩短（162分钟vs 185分钟，p < 0.001）。术后结果方面，RLC组总体发病率较高（20.5% vs 13.3%, p = 0.03），肠梗阻（10.6 vs 2.4%, p < 0.001），住院时间较长（4.7 vs 3.9天，p = 0.003），在再手术、再入院或死亡率方面无差异。多因素分析显示，RLC与较长的手术时间和术后肠梗阻独立相关。与大容量中心的左腹腔镜结肠切除术相比，结肠癌的RLC与更短的手术时间、更高的肠梗阻风险和更长的住院时间独立相关。
To compare the intraoperative and postoperative outcomes between right laparoscopic colectomy (RLC) and left laparoscopic colectomy (LLC) for colon cancer.Patients who underwent elective RLC or LLC for colon cancer between January 2004 and December 2014 were identified and elected for a retrospective analysis. Primary outcomes were technical difficulty (including operative time, intraoperative complications, and conversion rate) and postoperative outcome (including postoperative complications, length of hospital stay, reinterventions, readmissions, and mortality).A total of 547 patients (mean age: 68.5 years old; 48.4% males) were analyzed. The RLC group had a higher mean age (71 vs 65; p < 0.001), ASA 3/4 grade (36 vs 26%; p = 0.02), and comorbidity rate (61 vs 48%, p = 0.003). Regarding technical difficulty, no difference was found between the groups in intraoperative complications (4.1 vs 5.9%; p = 0.34) or conversion rate (6.2 vs 3.9%, p = 0.24). Mean operative time was significantly shorter for RLC (162 vs 185 min, p < 0.001). Regarding postoperative outcome, the RLC group had a higher overall morbidity (20.5 vs 13.3%, p = 0.03), ileus (10.6 vs 2.4%, p < 0.001), and a longer hospital stay (4.7 vs 3.9 days, p = 0.003), with no differences regarding reoperations, readmissions, or mortality. The multivariate analysis showed that RLC were independently associated with a longer operative time and postoperative ileus.RLC for colon cancer was independently associated with a shorter operative time, an increased risk of ileus, and a longer hospital stay than left laparoscopic colectomy in high-volume centers.