徐徕;肖毅;林国乐;吴斌;牛备战;孙曦羽;邱辉忠;
XU Lai;XIAO Yi;LIN Guo-le;WU Bin;NIU Bei-zhan;SUN Xi-yu;QIU Hui-zhong;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院基本外科

摘要(Abstract)：

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。
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.

关键词(KeyWords)： Ⅲ期结肠肿瘤;腹腔镜手术;预后分析
stage Ⅲ colon cancer;laparoscopic surgery;outcome analysis

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 徐徕;肖毅;林国乐;吴斌;牛备战;孙曦羽;邱辉忠;
XU Lai;XIAO Yi;LIN Guo-le;WU Bin;NIU Bei-zhan;SUN Xi-yu;QIU Hui-zhong;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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DOI:

参考文献(References)：

• [1]Siegel R,Naishadham D,Jemal A.Cancer statistics,2013[J].CA Cancer J Clin,2013,63:11-30.
• [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.
• [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.
• [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.
• [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.
• [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.
• [7]Berends FJ,Kazemier G,Bonjer HJ,et al.Subcutaneous metastases after laparoscopic colectomy[J].Lancet,1994,344:58.
• [8]Johnson PM,Porter GA,Ricciardi R,et al.Increasing negative lymph node count is independently associated with improved long-term survival in stageⅢB andⅢC colon cancer[J].J Clin Oncol,2006,24:3570-3575.
• [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 stageⅢcolon cancer[J].J Surg Oncol,2011,103:406-410.
• [10]Lykke J,Roikjaer O,Jess P.The relation between lymph node status and survival in StageⅠ-Ⅲcolon cancer:results from a prospective nationwide cohort study[J].Colorectal Dis,2013,15:559-565.
• [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.
• [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.
• [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.
• [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.