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首页> 外文期刊>Surgical Endoscopy >Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients.
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Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients.

机译：腹腔镜与开放式切除术对124例未选患者的直肠癌的长期结果。

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Background: Controversy continues to surround laparoscopic rectal resection for malignancy. A longer follow-up period is required to evaluate the long-term efficacy of the procedure and its impact on survival. Furthermore, no data from ongoing randomized controlled trials are yet available. The aims of this study were to compare long-term outcomes for unselected patients undergoing either laparoscopic or open rectal resection for cancer. Methods: A series of 124 unselected consecutive patients with rectal cancer, who underwent surgery by the same surgical team, have been included in this study. Patients with T1N0 tumors underwent local excision, and emergency cases were excluded from the study. Written consent was submitted by each patient, and inclusion in either group (laparoscopic or open) was left to the patient's choice. The laparoscopic approach was chosen by 81 patients, and 43 patients chose open surgery. All the patients underwent preoperative radiotherapy (5,040 cGy), performed in selected cases with chemotherapy (for patients younger than 70 years). The following parameters were compared between the two groups: length of the surgical specimen, clearance of the margins of the specimen, number of lymph nodes identified, local recurrence rate, incidence of distant metastases, and survival probability analysis. The mean follow-up period for both groups was 43.8 months (range, l-9 years). Results: We performed 60 laparoscopic and 27 open anterior resections, as well as 21 laparoscopic and 16 open abdomino perineal resections, respectively. No mortality occurred in either group. The mean length of the resected specimens was 24.3 cm in the laparoscopic group and 23.8 cm in the open group ( p = 0.47). The mean tumor-free margin was 3.0 cm in the laparoscopic group and 2.8 cm in the open group ( p = 0.57), and the mean number of lymph nodes identified was 10.3 in the laparoscopic group and 9.8 in the open group ( p = 0.63). Of the 124 patients, 86 (52 laparoscopic and 34 open) were included in out study. We excluded patients who underwent a palliative resection (6 laparoscopic and 6 open patients) or conversion to open surgery ( n = 10) and patients who had undergone surgery in the past year ( n = 16). One laparoscopic patient was lost to follow-up evaluation, whereas three laparoscopic patients and one open patient died of causes not related to cancer. No wound recurrence was observed. The local recurrence rate after laparoscopic resection was 20.8%, as compared with 16.6% after open resection ( p = 0.687). Distant metastases occurred in 18.2% of the patients in the laparoscopic group, as compared with 21.2% in the open group ( p = 0.528). Cumulative survival probability was 0.709 after laparoscopic resection after LR and 0.606 after open resection ( p = 0.162), whereas for Dukes' stages A, B, and C in the laparoscopic group versus the open group, it was 0.875 vs 0.889 ( p = 0.392), 0.722 vs 0.584 ( p = 0.199), and 0.500 vs 0.417 ( p = 0.320), respectively. At this writing 20 laparoscopic patients (62.5%) and 20 open patients (60.6%) are disease free ( p = 0.623). Conclusions: Oncologic surgical principles were respected. Long-term outcome after laparoscopic resection of rectal cancer was comparable with that after conventional resection. We should wait to draw conclusive scientific statements until the completion of ongoing international radomized controlled trials.
机译：背景：腹腔镜直肠癌切除术仍在引起争议。需要较长的随访时间来评估该手术的长期效果及其对生存的影响。此外，尚无正在进行的随机对照试验的数据。这项研究的目的是比较未选择的接受腹腔镜或直肠直肠癌切除术的患者的长期结局。方法：本研究纳入了由同一手术团队接受手术的一系列124例未选择的连续性直肠癌患者。 T1N0肿瘤患者接受了局部切除，紧急病例被排除在研究之外。每位患者均提交书面同意书，然后将其纳入两组（腹腔镜或开放式）由患者选择。 81例患者选择了腹腔镜手术，43例患者选择了开放手术。所有患者均接受术前放疗（5,040 cGy），在部分病例中进行了化疗（针对70岁以下的患者）。在两组之间比较了以下参数：手术标本的长度，标本边缘的清除率，确定的淋巴结数目，局部复发率，远处转移的发生率和生存概率分析。两组的平均随访时间为43.8个月（范围1至9年）。结果：我们分别进行了60例腹腔镜和27例开放性前切除术，以及21例腹腔镜和16例开放性会阴腹腔切除术。两组均无死亡发生。腹腔镜组切除的标本的平均长度为24.3 cm，开放组为23.8 cm（p = 0.47）。腹腔镜组的平均无肿瘤切缘为3.0 cm，开放组为2.8 cm（p = 0.57），腹腔镜组的平均无淋巴结数目为10.3，开放组为9.8（p = 0.63） ）。在124例患者中，有86例（52例腹腔镜和34例开放）被纳入研究。我们排除了接受姑息性切除术（6例腹腔镜手术和6例开放手术）或转为开放手术的患者（n = 10）以及在过去一年中接受过手术的患者（n = 16）。一名腹腔镜患者失去了随访评估，而三名腹腔镜患者和一名开放患者死于与癌症无关的原因。没有观察到伤口复发。腹腔镜切除术后的局部复发率为20.8％，而开放切除术后的局部复发率为16.6％（p = 0.687）。腹腔镜组患者发生远处转移的比例为18.2％，而开放组患者中发生转移的比例为21.2％（p = 0.528）。 LR腹腔镜切除后的累积生存概率为0.709，开腹切除后的累积生存率为0.606（p = 0.162），而腹腔镜组与开放组的Dukes的A，B和C期分别为0.875和0.889（p = 0.392） ），分别为0.722对0.584（p = 0.199）和0.500对0.417（p = 0.320）。在撰写本文时，20例腹腔镜患者（62.5％）和20例开放患者（60.6％）没有病（p = 0.623）。结论：肿瘤手术原则得到尊重。腹腔镜切除直肠癌后的长期结果与常规切除后相当。我们应该等待得出结论性的科学声明，直到完成正在进行的国际随机对照试验。

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