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首页> 外文期刊>Surgical Endoscopy >Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome.
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Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome.

机译：腹腔镜直肠切除术并保留肛门括约肌用于直肠癌：长期结果。

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BACKGROUND: Total mesorectal excision (TME) is the surgical gold standard treatment for middle and low third rectal carcinoma. Laparoscopy has gradually become accepted for the treatment of colorectal malignancy after a long period of questions regarding its safety. The purposes of this study were to examine prospectively our experience with laparoscopic TME and high rectal resections, to evaluate the surgical outcomes and oncologic adequacy, and to discuss the role of this procedure in the treatment of rectal cancer. METHODS: Between December 1992 and December 2004, all patients who underwent elective laparoscopic sphincter preserving rectal resection for rectal cancer were enrolled prospectively in this study. Data collection included preoperative, operative, postoperative and oncologic results with long-term follow-up. RESULTS: A total of 218 patients were operated on during the study period: 142 patients underwent laparoscopic TME and 76 patients underwent anterior resection. Of the TME patients, 122 patients were operated using the double-stapling technique, and 20 patients underwent colo-anal anastomosis with hand-sewn sutures. Mean operative time was 138 min (range, 107-205), and mean blood loss was 120 ml (range, 30-350). Conversion to open surgery occurred in 26 cases (12%). Mortality rate during the first 30 days was 1%. Anastomotic leaks were observed in 10.5% of the patients. Of these, 61.9% needed reoperation and diverting stoma, and the rest were treated conservatively. Three patients had postoperative bleeding requiring relaparoscopy. Other minor complications (infection and urinary retention) occurred in 9.1% of patients. Mean ambulation time and mean hospital stay were 1.6 days (range, 1-5) and 6.4 days (range, 3-28) , respectively. Patients were followed for a mean period of 57 months. No port site metastases were observed during follow-up. The recurrence rate was 6.8 %. Overall survival rate was 67% after 5 years and 53.5% after 10 years. CONCLUSION: Laparoscopic anterior resection and TME with anal sphincter preservation for rectal cancer is feasible and safe. The short- and long-term outcomes reported in this series are comparable with those of conventional surgery.
机译：背景：全直肠系膜切除术（TME）是中，低度第三直肠癌的手术金标准治疗。在长期对其安全性提出质疑之后，腹腔镜已逐渐被接受用于治疗大肠恶性肿瘤。这项研究的目的是前瞻性地检查我们在腹腔镜TME和直肠高位切除术方面的经验，评估手术结果和肿瘤学充分性，并讨论该方法在直肠癌治疗中的作用。方法：在1992年12月至2004年12月之间，所有接受选择性直肠癌保留腹腔镜括约肌切除术的直肠癌患者均前瞻性纳入本研究。数据收集包括术前，术中，术后和肿瘤学结果，并进行长期随访。结果：在研究期间，共有218例患者接受了手术：142例接受了腹腔镜TME，76例接受了前切除术。在TME患者中，有122例采用双吻合术进行了手术，还有20例经手工缝合的结肠肛门吻合术。平均手术时间为138分钟（范围107-205），平均失血为120毫升（范围30-350）。有26例（12％）转变为开放手术。前30天的死亡率为1％。 10.5％的患者出现吻合口漏。其中，有61.9％的患者需要再次手术和转移造口，其余的则接受保守治疗。三名患者术后出血需要腹腔镜检查。其他轻微并发症（感染和尿minor留）发生在9.1％的患者中。平均步行时间和平均住院天数分别为1.6天（范围为1-5）和6.4天（范围为3-28）。随访患者平均57个月。随访期间未观察到港口部位转移。复发率为6.8％。 5年后总生存率为67％，10年后为53.5％。结论：腹腔镜前切除术和TME联合肛门括约肌保留术治疗直肠癌是可行和安全的。该系列报道的短期和长期结局与常规手术相当。

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