翻譯：清遠(yuǎn)市第二人民醫(yī)院普外科 劉為民

審校：暨南大學(xué)附屬華僑醫(yī)院胃腸減重外科 董志勇博士

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

Clinically suspected T4 colorectal cancer maybe resected using a laparoscopic approach

臨床懷疑T4的結(jié)直腸癌可以通過(guò)腹腔鏡方法切除

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：腹腔鏡切除臨床懷疑T4的結(jié)直腸癌的作用尚存在爭(zhēng)論。本研究的目的在于比較臨床T4期結(jié)直腸癌患者經(jīng)腹腔鏡切除和開放切除的長(zhǎng)期結(jié)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.

通過(guò)CT或/和MRI檢查懷疑T4期結(jié)直腸癌的患者共293例接受了治愈性切除手術(shù)。

Results:

結(jié)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.

所有病例盡管懷疑為T4期患者，術(shù)后與病理學(xué)結(jié)果一致的病例只占37.9 %。腹腔鏡組71例病人，4例（5.6 %）中轉(zhuǎn)為開放手術(shù)。

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),

腹腔鏡組病例有明顯較低的出血量(p <0.001),較短的手術(shù)后第一次排氣，和住院天數(shù)和較少的并發(fā)癥發(fā)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).

中位隨訪36個(gè)月，兩組間5年無(wú)疾病生存率沒有明顯差別(81.8 %腹腔鏡組 vs 73.9% 開放組, 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).

研究發(fā)現(xiàn)預(yù)測(cè)T4病理學(xué)分期的臨床因素為男性(p = 0.038),手術(shù)前癌胚抗原檢測(cè)值(p = 0.021),臨床淋巴結(jié)狀況(p = 0.046),臨床癌穿孔(p = 0.004)。

Conclusions:

結(jié)論：

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.

當(dāng)經(jīng)驗(yàn)的外科醫(yī)生手術(shù)時(shí)，T4期結(jié)直腸癌經(jīng)腹腔鏡切除術(shù)與開放方法相比圍手術(shù)期和長(zhǎng)期的結(jié)果具有相似的結(jié)果。

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

關(guān)鍵詞：臨床T4，結(jié)直腸癌，腹腔鏡，腫瘤學(xué)結(jié)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.

腹腔鏡外科手術(shù)對(duì)結(jié)直腸癌治療來(lái)說(shuō)已經(jīng)是一個(gè)完善的治療方法。一些隨機(jī)研究報(bào)告與常規(guī)手術(shù)方法相比，腹腔鏡法具有比較低的手術(shù)后疼痛、較短的住院時(shí)間和較少的術(shù)后不良事件。

最近，來(lái)自美國(guó)結(jié)直腸外科醫(yī)生學(xué)會(huì)和歐洲外科學(xué)會(huì)的指南建議，腹腔鏡手術(shù)對(duì)結(jié)直腸癌來(lái)說(shuō)應(yīng)為首選的方法。然而，對(duì)臨床T4的結(jié)直腸癌病人來(lái)說(shuō)，腹腔鏡切除仍存在爭(zhēng)議。關(guān)于此期病變臨床問(wèn)題包括較高的中轉(zhuǎn)開放率和較低的腫瘤切除質(zhì)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.

根據(jù)美國(guó)胃腸與內(nèi)鏡外科醫(yī)生學(xué)會(huì)指南(SAGES)推薦，局部進(jìn)展期結(jié)直腸癌應(yīng)該通過(guò)開放手術(shù)切除；然而，ASCRS指南建議腹腔鏡和開放的結(jié)腸切除手術(shù)對(duì)局限的結(jié)腸癌患者有相同的腫瘤學(xué)結(jié)果[5, 7]。有一些研究表明局部進(jìn)展期結(jié)直腸癌患者腹腔鏡方法是可行并有效的選擇，但是，目前可供參考的資料尚十分有限[8–13]。因此，本研究的目的在于比較腹腔鏡切除可開方法切除臨床T4的結(jié)直腸癌長(zhǎng)期和腫瘤學(xué)結(jié)果。