Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer:: a randomised trial
Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer:: a randomised trial
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DOI：
10.1016/s0140-6736(02)09290-5
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发表时间：
2002-06-29
期刊：
影响因子：
168.9
通讯作者：
Visa, J
中科院分区：
文献类型：
--
作者：
Lacy, AM;García-Valdecasas, JC;Visa, J
背景：虽然早期关于结肠癌患者的腹腔镜辅助结肠切除术(LAC)的报道表明，它可以减少围手术期的发病率，但它对长期结果的影响尚不清楚。本研究旨在比较LAC和开腹结肠癌切除术(OC)治疗非转移性结肠癌的复发和生存率。方法1993年11月至1998年7月，所有结肠腺癌患者进入这项随机试验。两组的辅助治疗和术后随访相同。主要终点是与癌症相关的存活率。根据意向治疗原则对数据进行分析，共发现219例患者参与研究(LAC组111例，OC组108例)。与OC组相比，LAC组患者恢复更快，蠕动检测(p=0.001)和口服时间(p=0.001)更短，住院时间更短(p=0.005)。虽然LAC不影响围手术期死亡率，但LAC组的发病率较低(p=0.001)。LAC组的癌症相关生存概率较高(p=0.02)。COX模型显示，与OC相比，LAC与肿瘤复发风险(风险比0.39，95%CI 0.19-0.82)、任何原因死亡(0.48，0.23-1.01)和癌症相关原因死亡(0.38，0.16-0.91)独立相关。这一优势归因于III期肿瘤患者的差异(分别为p=0.04、p=0.02和p=0.006)。就发病率而言，解释性LAC治疗结肠癌比OC更有效。住院时间、肿瘤复发和癌症相关生存率。
Background Although early reports on laparoscopy-assisted colectomy (LAC) in patients with colon cancer suggested that it reduces perioperative morbidity, its influence on long-term results is unknown. Our study aimed to compare efficacy of LAC and open colectomy (OC) for treatment of non-metastatic colon cancer in terms of turnout recurrence and survival.Methods From November, 1993, to July, 1998, all patients with adenocarcinoma of the colon were assessed for entry in this randomised trial. Adjuvant therapy and postoperative follow-up were the same in both groups. The main endpoint was cancer-related survival. Data were analysed according to the intention-to-treat principle.Findings 219 patients took part in the study (111 LAC group, 108 OC group). Patients in the LAC group recovered faster than those in the OC group, with shorter peristalsis-detection (p=0.001) and oral-intake times (p=0.001), and shorter hospital stays (p=0.005). Morbidity was lower in the LAC group (p=0.001), although LAC did not influence perioperative mortality. Probability of cancer-related survival was higher in the LAC group (p=0.02). The Cox model showed that LAC was independently associated with reduced risk of tumour relapse (hazard ratio 0.39, 95% Cl 0.19-0.82), death from any cause (0.48, 0.23-1.01), and death from a cancer-related cause (0.38, 0.16-0.91) compared with OC. This superiority of LAC was due to differences in patients with stage III tumours (p=0.04, p=0.02, and p=0.006, respectively).Interpretation LAC is more effective than OC for treatment of colon cancer in terms of morbidity. hospital stay, tumour recurrence, and cancer-related survival.