Comparison of Long-Term Follow Up of Laparoscopic Versus Open Colectomy for Transverse Colon Cancer
Comparison of Long-Term Follow Up of Laparoscopic Versus Open Colectomy for Transverse Colon Cancer
复制标题
腹腔镜与开腹结肠切除术治疗横结肠癌的长期随访比较
作者：
S. Agarwal;Mikhail Gincherman;E. Birnbaum;J. Fleshman;M. Mutch
手术治疗的临床结果 (COST) 是一项具有里程碑意义的研究，表明腹腔镜辅助结肠切除术的肿瘤学结果与结肠癌开腹结肠切除术相似，但横结肠癌 (TCC) 被排除在该研究之外。腹腔镜切除 TCC 的肿瘤学结果尚不清楚。这项单机构回顾性3:1病例匹配审查检查了1996年1月1日至2009年4月15日接受TCC治疗的患者。分析了针对横结肠（肝曲、横结肠和脾曲）I至III期腺癌完成的腹腔镜结肠切除术（LC）和开腹结肠切除术（OC；扩大右侧、扩大左侧和全腹部）病例。患者的年龄、肿瘤位置和分期进行了匹配。主要终点是总生存期和无病生存期。次要终点是住院时间和病理参数。 123 例 OC 病例与 41 例 LC 病例相匹配。 LC 组中有 4 例转化（9.7%）。 LC 组的住院时间减少了 28% (P = 0.02)。两组的并发症发生率和严重程度相似（29% vs 24%；P = 0.68）。 LC 组的淋巴结收获量高于 OC 组（23.3 vs 18.6；P = 0.03）。两组病理切缘均清晰，均未发现局部复发。两组的五年总生存率（61% vs 59%；P = 0.39）和无病生存率（88% vs 82%；P = 0.23）相似。 LC 组的短期恢复更快，淋巴结采集也得到改善。因此，腹腔镜治疗TCC是一种安全可行的手术。
Clinical Outcomes of Surgical Therapy (COST) was a landmark study demonstrating that laparoscopic-assisted colectomy had oncologic outcomes similar to those of open colectomy for colon cancer, but transverse colon cancers (TCCs) were excluded from that study. Oncologic results of a laparoscopic resection for TCC are unknown. This single-institution retrospective 3:1 case-matched review examined patients treated for TCC from January 1, 1996, to April 15, 2009. Laparoscopic colectomy (LC) and open colectomy (OC; extended right, extended left, and total abdominal) cases completed for Stage I to III adenocarcinoma of the transverse colon (hepatic flexure, transverse colon, and splenic flexure) were analyzed. Patients were matched for age, tumor location, and stage. Primary endpoints were overall survival and disease-free survival. Secondary endpoints were length of stay and pathologic parameters. One hundred and twenty-three OC cases were matched with 41 LC cases. There were four conversions (9.7%) in the LC group. Length of stay was reduced by 28% in the LC group (P = 0.02). Complication rate and severity were similar between the two groups (29% vs 24%; P = 0.68). Lymph node harvest was higher in the LC group than in the OC group (23.3 vs 18.6; P = 0.03). All pathologic margins were clear, and no local recurrence was found in either group. Five-year overall survival (61% vs 59%; P = 0.39) and disease-free survival (88% vs 82%; P = 0.23) were similar in the two groups. Short-term recovery was faster and lymph node harvest was improved in the LC group. Thus, laparoscopic management of TCC is a safe and feasible procedure.