Laparoscopic colorectal cancer surgery in obese patients
Laparoscopic colorectal cancer surgery in obese patients
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DOI：
10.1111/j.1463-1318.2010.02348.x
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发表时间：
2011-08-01
影响因子：
3.4
通讯作者：
Motson, R. W.
中科院分区：
文献类型：
--
作者：
Singh, A.;Muthukumarasamy, G.;Motson, R. W.
目的探讨肥胖患者行腹腔镜结直肠癌根治术的肿瘤学和术后疗效。方法将2005年1月至2008年1月期间接受腹腔镜结直肠癌根治术的肥胖患者（BMI > 30）与接受类似手术的非肥胖患者进行比较。我们记录了患者的人口统计学资料，术中的细节和术后发病率和mortals.Results 62肥胖和172非肥胖患者进行腹腔镜结直肠癌切除术。两组的人口统计学参数匹配良好。总体平均手术时间无显著差异。肥胖患者更有可能转为开放手术。特别是对于直肠癌，肥胖组的转化率为44%，而非肥胖组为17%（P < 0.05）。肥胖患者术后并发症发生率明显高于肥胖患者（P < 0.05）。腹腔镜手术完成的病例住院时间相似（肥胖组6天，非肥胖组7天），但肥胖转换组为14天（P < 0.05）。肥胖和非肥胖患者的切除标本在长度、切缘和淋巴结回收方面是等同的。无病生存率和总生存率在中位随访2 years也similar.Conclusions腹腔镜结直肠癌手术治疗肥胖患者在技术上是可行的，肿瘤安全。尽管术后发病率较高，但肥胖患者的住院时间较短。然而，预计肥胖男性患者的转化率会更高，特别是对于直肠癌。
Aim The aim of this study was to assess the oncological and postoperative outcomes of laparoscopic colorectal cancer surgery in obese patients.Method All obese (BMI > 30) patients who underwent laparoscopic colorectal cancer surgery from January 2005 to January 2008 were compared with nonobese patients undergoing similar surgery. We recorded patient demographics, intra-operative details and postoperative morbidity and mortality.Results Sixty-two obese and 172 nonobese patients underwent laparoscopic colorectal cancer resection. Both groups were well matched for demographic parameters. Overall mean operating times were not significantly different. Conversion to open surgery was more likely in obese patients. In particular, for rectal cancers, the conversion rate was 44% in the obese group compared with 17% in the nonobese group (P < 0.05). Postoperative morbidity was also greater in obese patients (P < 0.05). The duration of hospital stay was similar for laparoscopically completed cases (6 days obese vs 7 days nonobese), but in the obese-converted group it was 14 days (P < 0.05). The resected specimen with respect to length, resection margin and lymph node retrieval was equivalent between obese and nonobese patients. Disease-free survival and overall survival at a median follow up of 2 years were also similar.Conclusions Laparoscopic colorectal cancer surgery in obese patients is technically feasible and oncologically safe. Despite greater postoperative morbidity, obese patients benefit from shorter length of stay. However, a higher conversion rate, particularly for rectal cancers, should be anticipated in obese male patients.