T4结直肠癌可以通过腹腔镜切除

翻译：清远市第二人民医院普外科 刘为民

审校：暨南大学附属华侨医院胃肠减重外科 董志勇博士

Park et al. BMC Cancer (2016) 16:714

Clinically suspected T4 colorectal cancer maybe resected using a laparoscopic approach

临床怀疑T4的结直肠癌可以通过腹腔镜方法切除

Jong SeobPark1 , Jung Wook Huh2*, Yoon Ah Park2 , Yong Beom Cho2 , Seong Hyeon Yun2*, HeeCheol Kim2, Woo Yong Lee2 and Ho-Kyung Chun3

Abstract

摘要

Background:The role of laparoscopic resection in patients with clinically suspicious T4 colorectal cancer remains controversial. The aim of this study was to compare the long-term and oncologic outcomes of laparoscopic resection and the open approach in clinical T4 colorectal cancer.

背景：腹腔镜切除临床怀疑T4的结直肠癌的作用尚存在争论。本研究的目的在于比较临床T4期结直肠癌患者经腹腔镜切除和开放切除的长期结果。

Methods:

方法：

Two hundred ninety-three consecutive patients undergoing curative surgery for colorectal cancer suspected to be T4 by computed tomography and/or magnetic resonance imaging were reviewed.

通过CT或/和MRI检查怀疑T4期结直肠癌的患者共293例接受了治愈性切除手术。

Results:

结果：

Despite clinical suspicion of T4 disease in all cases, concordance with pathologic determination of T4 was only 37.9 %. Of the 71 patients in the laparoscopic group, four (5.6 %) were converted to the open technique.

所有病例尽管怀疑为T4期患者，术后与病理学结果一致的病例只占37.9 %。腹腔镜组71例病人，4例（5.6 %）中转为开放手术。

Patients in the laparoscopic group had significantly lower estimated blood loss (p <0.001), fewer days to first flatus (p = 0.001), shorter length of hospital stay(p < 0.001), and fewer adverse events (14.1 % versus 31.5 %, p = 0.004). (p <0.001),

腹腔镜组病例有明显较低的出血量(p <0.001),较短的手术后第一次排气，和住院天数和较少的并发症发生率(14.1 % vs31.5 %, p= 0.004). (p < 0.001)

After amedian follow-up of 36 months, 5-year disease-free survival was not significantly different between the two groups (81.8 % in laparoscopic versus73.9 % in open surgery, p = 0.433).

中位随访36个月，两组间5年无疾病生存率没有明显差别(81.8 %腹腔镜组 vs 73.9% 开放组, p = 0.433)。

The clinical factors that predicted T4 staging on pathologic examination were found to be male sex (p = 0.038), preoperative carcinoembryonic antigen status (p = 0.021),clinical N status (p = 0.046), and clinical cancer perforation (p = 0.004).

研究发现预测T4病理学分期的临床因素为男性(p = 0.038),手术前癌胚抗原检测值(p = 0.021),临床淋巴结状况(p = 0.046),临床癌穿孔(p = 0.004)。

Conclusions:

结论：

Laparoscopic colorectal resection for T4 colorectal cancer has perioperative and long-term oncologic outcomes similar to those of the open approach when performed by an experienced surgeon.

当经验的外科医生手术时，T4期结直肠癌经腹腔镜切除术与开放方法相比围手术期和长期的结果具有相似的结果。

Keywords:Clinical T4, Colorectal cancer, Laparoscopy, Oncologic outcome

关键词：临床T4，结直肠癌，腹腔镜，肿瘤学结果。

Background

背景

Laparoscopic surgery is a well-established treatment approach for colorectal cancer. Several randomized studies have reported that the laparoscopic approach is associated with decreased postoperative pain, shorter hospital stay, and reduced postoperative adverse events compared to conventional surgery [1–4].Recently,the guidelines from the American Society of Colon & Rectal Surgeons (ASCRS)and the European Association of Endoscopic Surgery have suggested that a laparoscopic approach is the optimal technique for colorectal cancer resection[5–7].However,the role of laparoscopic resection in patients with clinically suspected T4 colorectal cancer remains controversial. The concerns regarding laparoscopy at this stage of disease include higher risk of conversion and lower quality of oncologic resection.

腹腔镜外科手术对结直肠癌治疗来说已经是一个完善的治疗方法。一些随机研究报告与常规手术方法相比，腹腔镜法具有比较低的手术后疼痛、较短的住院时间和较少的术后不良事件。

最近，来自美国结直肠外科医生学会和欧洲外科学会的指南建议，腹腔镜手术对结直肠癌来说应为首选的方法。然而，对临床T4的结直肠癌病人来说，腹腔镜切除仍存在争议。关于此期病变临床问题包括较高的中转开放率和较低的肿瘤切除质量。

It is recommended that resection for locally advanced colorectal cancer be performed via an open approach, according to the Society of American Gastrointestinal and Endoscopic Surgeons guidelines (SAGES); however, the ASCRS guidelines suggest that laparoscopic and open colectomies result in equivalent oncological outcomes for localized colon cancer [5, 7].There are several studies showing that a laparoscopic approach in locally-advancedcolorectal cancer is a feasible and effective treatment option, but little information is currently available [8–13].Thus,the aim of this study was to compare the long-term and oncologic outcomes of laparoscopic resection and open approach for clinically suspected T4 colorectal cancer.

根据美国胃肠与内镜外科医生学会指南(SAGES)推荐，局部进展期结直肠癌应该通过开放手术切除；然而，ASCRS指南建议腹腔镜和开放的结肠切除手术对局限的结肠癌患者有相同的肿瘤学结果[5, 7]。有一些研究表明局部进展期结直肠癌患者腹腔镜方法是可行并有效的选择，但是，目前可供参考的资料尚十分有限[8–13]。因此，本研究的目的在于比较腹腔镜切除可开方法切除临床T4的结直肠癌长期和肿瘤学结果。