Comparative study of laparoscopic versus open technique for simultaneous resection of colorectal cancer and liver metastases with propensity score analysis
Comparative study of laparoscopic versus open technique for simultaneous resection of colorectal cancer and liver metastases with propensity score analysis
复制标题
DOI：
10.1007/s00464-019-07253-4
复制
发表时间：
2019-11-15
影响因子：
3.1
通讯作者：
Kim, Jong Man
中科院分区：
文献类型：
--
作者：
Shin, Jung Kyong;Kim, Hee Cheol;Kim, Jong Man
背景转移性结直肠癌(CRC)的腹腔镜肝切除术仍存在争议。本研究的目的是比较接受腹腔镜结直肠切除和开腹结直肠切除并同时切除肝转移的结直肠癌患者的短期和中期结果。方法2008-2016年间，126例结直肠癌同期肝转移患者接受了腹腔镜联合切除术。在上述期间，共有318名患者接受了开放手术。采用倾向性评分匹配的方法，对109例腹腔镜手术患者和109例开腹手术患者进行比较。分析的变量包括患者特征、肿瘤特征以及短期和中期结果。结果倾向评分匹配后，两组患者的人口学特征和病理结果相似。3例(2.8%)接受腹腔镜肝切除术的患者中转开腹手术。两组在住院时间(p=0.078)、输血率(p=0.686)、肠功能恢复时间(p=0.570)方面无明显差异。腹腔镜组和开腹组的3年总生存率(74.4%比79.1%；p=0.792)和3年无瘤生存率(58.5%比55.2%；p=0.391)相似。然而，腹腔镜组的术后并发症发生率显著低于腹腔镜组(20.2%vs.33.0%；p=0.032)。结论与开腹手术相比，腹腔镜结直肠切除联合肝转移瘤切除可获得满意的肿瘤学效果，并具有一定的短期优势。因此，在结直肠癌患者中，腹腔镜术可替代开腹手术同时切除肝和结肠。
Background Laparoscopic liver resection for metastatic colorectal cancer (CRC) remains controversial. The objective of this study was to compare the short-term and mid-term outcomes of patients with CRC undergoing laparoscopic versus open colorectal resection with simultaneous resection for liver metastases. Methods A total of 126 patients underwent combined laparoscopic resection of CRC and synchronous colorectal liver metastases between 2008 and 2016. A total of 318 patients were treated by an open approach during the above period. By propensity score matching, 109 patients who underwent laparoscopic resection and 109 patients who had an open approach were compared. Analyzed variables included patient characteristics, tumor features, and short-term and mid-term outcomes. Results Demographic features and pathologic outcomes were similar in both groups after propensity score matching. Three (2.8%) patients undergoing laparoscopic liver resection experienced conversion to open procedure. There was no difference in hospital stay (p = 0.078), transfusion rate (p = 0.686), or time of bowel function return (p = 0.570) between the two groups. The laparoscopic group and the open approach group also showed similar 3-year overall survival rate (74.4% vs. 79.1%;p = 0.792) and 3-year disease-free survival rate (58.5% vs. 55.2%;p = 0.391). However, postoperative morbidity rate was significantly lower in the laparoscopic group (20.2% vs. 33.0%;p = 0.032). Conclusions Laparoscopic colorectal resection with simultaneous resection of liver metastases showed satisfactory oncologic outcomes with some short-term advantages compared to the open approach. Thus, laparoscopic approach could be a good alternative of open approach for simultaneous liver and colon resection in patients with CRC.