Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis
Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis
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DOI：
10.1007/s00464-015-4704-x
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发表时间：
2016-09-01
影响因子：
3.1
通讯作者：
Pigazzi, Alessio
中科院分区：
文献类型：
--
作者：
Hanna, Mark H.;Hwang, Grace S.;Pigazzi, Alessio
腹腔镜右半结肠切除术的应用已经得到普及，允许选择全腹腔镜体内吻合（IA）进行肠道重建。这项技术可以减轻外科医生在腹腔镜辅助体外吻合术（EA）中面临的一些技术限制。回顾性分析了2005年3月至2014年6月在三家医院由四名结直肠外科医生连续行腹腔镜右半结肠切除术的195例患者。采用多变量回归分析比较术后和肿瘤预后。在研究期间，共有195例患者接受了腹腔镜右半结肠切除术，其中86例（44%）患者接受了IA， 109例（56%）患者接受了EA。两组中最常见的手术指征是癌症：56例（65%）IA病例和57例（52%）EA病例。与EA相比，IA的轻微并发症发生率明显高于EA，但严重并发症发生率无差异。EA转行开放切除的发生率更高。通过多因素分析比较，IA与EA在住院时间、肠功能恢复、吻合口漏风险、腹内脓肿风险、伤口并发症风险等方面均无显著差异。在肿瘤切除术中，淋巴结清扫的中位数差异无统计学意义（IA组18个淋巴结，EA组19个淋巴结，P < 0.05）。两组患者的总生存期和无病生存期（5.7年）也无显著差异。腹腔镜右半结肠切除术的IA与EA相比具有相似的术后和肿瘤预后。IA可能在标本提取的转换和灵活性方面具有优势，但这被较高的轻微并发症发生率所抵消。这些发现表明，在经验丰富的结直肠外科医生的军械库中，IA是一种有效的技术，不会影响结果。
The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA).A retrospective chart review of 195 consecutive patients who underwent laparoscopic right hemicolectomy by four colorectal surgeons at three institutions from March 2005 to June 2014 was performed. Multivariate regression analysis was used to compare postoperative and oncologic outcomes.A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups.IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.