腹腔镜直肠癌外科规范化治疗

Standardization of laparoscopic surgery in treating rectal cancers

尽管腹腔镜技术在结肠癌手术中已经被证实和开腹手术具有相同的可靠性和肿瘤根治性,但腹腔镜直肠癌的安全性和长期疗效还存在争论。腹腔镜中低位直肠癌手术要遵循和开腹手术相同的手术原则,并越来越多的被接受和开展。目前资料显示腹腔镜直肠癌手术可以有更好的短期疗效,表现为术后更轻的疼痛、更快的肠功能恢复以及更短的住院时间等。在无病生存率、总生存率及局部复发率等方面同开腹手术相同。上述结论还需要更多的大规模随机对照的临床研究进行证实。

Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent short-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic surgery for extraperitoueal（ mid- and low-） rectal cancer is feasible and widely accepted. The laparoscopic approach as open surgery offers the same quality of surgical specimen. Short-term outcomes such as bowel function, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not inferior to the open surgery in terms of disease-free survival, overall survival or local recurrence. Laparoscopic surgery for mid- and low-rectal cancer could be recommended under optimal conditions. Upcoming results from large randomized trials are needed to strengthen the evidence for improved clinical outcome in comparison with the open approach.