腹腔镜切除术治疗Ⅲ期结肠癌的长期预后

徐徕; 肖毅; 林国乐; 吴斌; 牛备战; 孙曦羽; 邱辉忠

doi:10.3969/j.issn.1674-9081.2015.04.006

腹腔镜切除术治疗Ⅲ期结肠癌的长期预后

Long-term Outcomes of Laparoscopic Surgery for Stage Ⅲ Colon Cancer

摘要

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.

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