新辅助同步放化疗对腹腔镜直肠癌手术近期效果的影响

Impact of neoadjuvant chemoradiotherapy on short-term outcomes of laparoscopic surgery for rectal cancer

目的探讨新辅助同步放化疗(nCRT)后行腹腔镜手术治疗中低位直肠癌的安全性及可行性。方法回顾性分析56例接受新辅助放化疗后行腹腔镜手术(LAP)的直肠癌患者的临床资料(CRT+LAP组),与同期147例直接行腹腔镜手术的中低位直肠癌患者的临床资料(LAP组)进行对比分析。结果两组患者年龄、性别、体重指数、ASA分级、术前合并症、手术方式及临床分期等方面差异无统计学意义。CRT+LAP组和LAP组中转开腹率分别为7.1%和8.8%,差异无统计学意义(X2=0.012,P=0.914)。两组患者的手术时间、术中出血量、术后排气时间和术后住院时间差异均无统计学意义(P<0.05)。CRT+LAP组和LAP组术后并发症发生率分别为12.5%和17.7%,差异无统计学意义(X2=0.801,P=0.371)。全组患者远端切缘均阴性,淋巴结检出数目CRT+LAP组平均为12.32枚,LAP组平均为15.47枚,两组差异有统计学意义(t=2.775,P=0.006)。结论新辅助放化疗后行腹腔镜直肠癌手术是安全、可行的,不增加中转开腹率及手术并发症。

Objective This study aimed to evaluate the feasibility and safety of laparoscopic- assisted resection after neoadjuvant chemoradiotherapy （nCRT） for rectal cancer. Methods We compared the short-term outcomes of laparoscopic rectal cancer surgery in patients with and without nCRT. Fifty-six patients underwent [aparoscopic surgery following nCRT （ CRT ＋ LAP group） and 147 patients received laparoscopic surgery without nCRT（ LAP group）. Results The two groups were similar in sex, age, body mass index, American Society of Anesthesiologists （ASA） score and other baseline characteristics. The convertion rate was 7. 1% in the CRT ＋ LAP group and 8.8% in the LAP group（ x^2 = 0.012, P = 0.914）. The two groups did not differ in operating time, blood loss, time of passing first flatus and postoperative hospitalization. The rate of perioperative complica- tions（ 12. 5% vs 17.7% ; %2 =0. 801, P = 0. 371 ） was similar between CRT ＋ LAP group and LAP group. None of the patients in either group had distal resection margin involved. The number of lymph node harvest was less in the CRT ＋ LAP group than in the LAP group （ 12. 32 vs 15.47 ; t = 2. 775, P = 0. 006 ）.Conclusions Laparoscopic surgery for rectal cancer following neoadjuvant CRT is safe and feasible, with no increase in convertion and perioperative complications.