作者投稿
专家审稿
编辑办公
邮件订阅
RSS
-
摘要:
目的 评价腹腔镜结肠癌根治性切除术治疗Ⅲ期结肠癌患者的临床疗效和长期预后。 方法 2007年1月至2012年12月北京协和医院基本外科结直肠专业组收治的169例Ⅲ期结肠癌患者分为腹腔镜组75例和开腹组94例。比较两组患者的临床病理特征以及5年局部复发率、总生存率和无病生存率等长期预后结果。 结果 腹腔镜组手术时间显著长于开腹组[(171.3±43.2)min比(132.7±60.4)min, P < 0.001], 但是术中出血量较少[(86.3±61.7)ml比(109.8±74.6)ml, P=0.030]。腹腔镜组检出淋巴结数目显著多于开腹组(23.3±12.2比19.3±9.6, P=0.022)。腹腔镜组和开腹组患者的累积局部复发率分别为6.7%和8.5%;5年总生存率分别为73.6%和58.8%;5年无病生存率分别为61.6%和56.3%;两组差异均无统计学意义(P > 0.05)。 结论 腹腔镜手术对于治疗Ⅲ期结肠癌安全可行, 其长期肿瘤学疗效不劣于传统开腹手术。 Abstract:Objective To investigate the clinical efficacy and long-term outcomes of laparoscopic radical resection for stage Ⅲ colon cancer. Methods A total of 169 stage Ⅲ colon cancer patients treated with laparoscopic surgery (n=75) or open surgery (n=94) between January 2007 and December 2012 in Department of General Surgery, Peking Union Medical College Hospital were included. The clinicopathologic features, as well as long-term outcomes including 5-year local recurrence rate, overall survival, and disease-free survival, were compared between the two groups. Results Compared with the open surgery group, the laparoscopic surgery group had significantly longer operation time[(171.3±43.2) minutes vs. (132.7±60.4) minutes, P < 0.001], significantly less blood loss[(86.3±61.7)ml vs. (109.8±74.6)ml, P=0.030], and significantly more invaded lymph nodes detected (23.3±12.2 vs. 19.3±9.6, P=0.022). No significant difference was found between the laparoscopic surgery group and open surgery group in cumulative local recurrence rate (6.7% vs. 8.5%, P=0.876), 5-year overall survival (73.6% vs. 58.8%, P=0.317), and 5-year disease-free survival (61.6% vs. 56.3%, P=0.544). Conclusion Laparoscopic colectomy is safe and effective for stage Ⅲ colon cancer, comparable with the conventional open colectomy in terms of long-term oncological outcomes. -
Key words:
- stage Ⅲ colon cancer /
- laparoscopic surgery /
- outcome analysis
-
表 1 Ⅲ期结肠癌患者临床病理特征
组别 性别(例) 年龄
(x±s，岁)术式(例) 手术时间
(x±s，min)出血量
(x±s，ml)组织分化程度(例) 淋巴结获取数目
(x±s)T分期(例) N分期(例) TNM分期(例) 男 女 右半结肠
切除术横结肠
切除术左半结肠
切除术乙状结肠
切除术高 中 低 T2 T3 T4 N1 N2 Ⅲa Ⅲb Ⅲc 腹腔镜组(n=75) 39 36 63.6±13.3 45 3 5 22 171.3±43.2 86.3±61.7 16 47 12 23.3±12.2 4 60 11 51 24 3 56 16 开腹组(n=94) 53 41 63.8±12.6 43 5 13 32 132.7±60.4 109.8±74.6 10 68 16 19.3±9.6 3 82 9 60 34 2 67 25 P值 0.680 0.929 0.341 ＜0.001 0.030 0.157 0.022 0.441 0.686 0.596 
下载: 导出CSV
表 2 Ⅲ期结肠癌患者术后复发、转移情况(例)
组别 局部复发 远处转移 吻合口 腹腔内 总计 肝 骨 肺 脑 卵巢 腹膜后 总计 腹腔镜组(n=75) 0 5 5 15 1 3 1 0 1 21 开腹组(n=94) 1 7 8 21 2 5 0 1 2 29
下载: 导出CSV
-
[1] Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013[J]. CA Cancer J Clin, 2013, 63:11-30. doi: 10.3322/caac.21166 [2] 万德森.我国结直肠癌的流行趋势及对策[J].中华肿瘤杂志, 2011, 33:481-483. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhzl201107001 [3] 肖毅, 邱辉忠, 吴斌, 等, 腹腔镜下根治性右半结肠切除术的手术效果和肿瘤学疗效[J].中华外科杂志, 2014, 52:249-253. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhwk201404003 [4] Wang CL, Qu G, Xu HW, et al. The short- and long-term outcomes of laparoscopic versus open surgery for colorectal cancer:a meta-analysis[J]. Int J Colorectal Dis, 2014, 29:309-320. doi: 10.1007/s00384-013-1827-1 [5] Fleshman J, Sargent DJ, Green E, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial[J]. Ann Surg, 2007, 246:655-662. doi: 10.1097/SLA.0b013e318155a762 [6] Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial):multicentre, randomised controlled trial[J]. Lancet, 2005, 365:1718-1726. doi: 10.1016/S0140-6736(05)66545-2 [7] Berends FJ, Kazemier G, Bonjer HJ, et al. Subcutaneous metastases after laparoscopic colectomy[J]. Lancet, 1994, 344:58. http://www.sciencedirect.com/science/article/pii/S0140673694910790 [8] Johnson PM, Porter GA, Ricciardi R, et al. Increasing negative lymph node count is independently associated with improved long-term survival in stage ⅢB and ⅢC colon cancer[J]. J Clin Oncol, 2006, 24:3570-3575. doi: 10.1200/JCO.2006.06.8866 [9] Hong KD, Lee SI, Moon HY. Lymph node ratio as determined by the 7th edition of the American Joint Committee on Cancer staging system predicts survival in stage Ⅲ colon cancer[J]. J Surg Oncol, 2011, 103:406-410. doi: 10.1002/jso.21830 [10] Lykke J, Roikjaer O, Jess P. The relation between lymph node status and survival in Stage Ⅰ-Ⅲ colon cancer:results from a prospective nationwide cohort study[J]. Colorectal Dis, 2013, 15:559-565. doi: 10.1111/codi.12059 [11] Lee JE, Joh YG, Yoo SH, et al. Long-term outcomes of laparoscopic surgery for colorectal cancer[J]. J Korean Soc Coloproctol, 2011, 27:64-70. doi: 10.3393/jksc.2011.27.2.64 [12] Balli JE, Franklin ME, Almeida JA, et al. How to prevent port-site metastases in laparoscopic colorectal surgery[J]. Surg Endosc, 2000, 14:1034-1036. doi: 10.1007/s004640000223 [13] Lacy AM, Delgado S, Castells A, et al.The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer[J]. Ann Surg, 2008, 248:1-7. doi: 10.1097/SLA.0b013e31816a9d65 [14] Jacob BP, Salky B. Laparoscopic colectomy for colon adenocarcinoma:an 11-year retrospective review with 5-year survival rates[J]. Surg Endosc, 2005, 19:643-649. doi: 10.1007/s00464-004-8921-y -
点击查看大图
图(2) / 表(2)
计量
- 文章访问数: 142
- HTML全文浏览量: 42
- PDF下载量: 15
- 被引次数: 0
