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首页> 外文期刊>Surgical Endoscopy >Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum.
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Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum.

机译：腹腔镜腹部手术切除和前切除术可治愈直肠癌。

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BACKGROUND: Within a 5-year period, 380 rectal carcinoma patients undergoing laparoscopic abdominoperineal excision or laparoscopic anterior resection were recruited to a multicenter study by 23 institutions in Germany and Austria. This study was initiated by the Laparoscopic Colorectal Surgery Study Group. RESULTS: One hundred forty-nine patients (39.2%) underwent abdominoperineal resection (APR), and 231 patients (60.8%) were treated by anterior resection (AR). The mean operating time was 208 min, and the conversion rate was 6.1%. Intraoperative complications, mostly vascular or bowel injuries, were observed in 22 patients (5.8%). Overall, a total of 257 postoperative complications and problems occurred in 143 patients, resulting in a morbidity rate of 37.6%. In the AR group, the anastomotic leakage rate increased as the distance of the tumor from the anal verge decreased. The perioperative mortality rate was low (6/1.6%). Most of the patients received a high transsection of the inferior mesenteric artery with radical lymph node dissection (342/90.0%); the mean number of recovered lymph nodes was 13.0, with considerable variation among the individual institutions. Intraoperative tumor cell spillage was reported in 12 patients (3.2%). Sufficient follow-up findings are available for 288 (77%) patients. To date, 19 patients have sustained a local recurrence (6.6%), and 30 (10.4%) have developed distant metastases. Within the (admittedly limited) mean follow-up of 24.8 months, the overall survival rate is 86.6%, the disease-free survival (freedom from both local recurrence and distant metastases) rate is 62.4% for APR, with the corresponding rates for AR being 71.7 and 54.8%, respectively, as established by the Kaplan-Meier function. These data show no alarmingly high recurrence rates at this time. CONCLUSION: In principle, laparoscopic anterior resection with curative intent generates considerably more reservations than laparoscopic abdominoperineal resection, which is technically much easier to perform.
机译：背景：在5年内，德国和奥地利的23家机构将380例接受腹腔镜腹腔手术切除或腹腔镜前切除术的直肠癌患者纳入多中心研究。这项研究是由腹腔镜结直肠外科研究小组发起的。结果：一百四十九例患者（39.2％）接受了腹部手术切除（APR），而231例患者（60.8％）接受了前切除术（AR）。平均操作时间为208分钟，转化率为6.1％。 22例患者（5.8％）观察到术中并发症，主要是血管或肠损伤。总体上，143例患者共发生257例术后并发症和问题，致残率为37.6％。在AR组中，随着肿瘤离肛门边缘的距离减小，吻合口漏率增加。围手术期死亡率低（6 / 1.6％）。大多数患者接受了肠系膜下动脉高位横断并淋巴结清扫术（342 / 90.0％）;回收的淋巴结平均数为13.0，各个机构之间差异很大。据报道有12例患者术中肿瘤细胞溢出（3.2％）。 288位患者（77％）有足够的随访结果。迄今为止，已有19例患者局部复发（6.6％），其中30例（10.4％）发生远处转移。在24.8个月的平均（有限的）随访期内，APR的总生存率为86.6％，无病生存率（无局部复发和远处转移）为62.4％，AR的相应发生率由Kaplan-Meier函数确定的分别为71.7和54.8％。这些数据目前没有显示出惊人的高复发率。结论：原则上，具有治愈意图的腹腔镜前切除术比腹腔镜腹部手术切除术产生更多保留，这在技术上更容易实现。

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