腹腔镜结肠癌根治术对Ⅰ、Ⅱ期结肠癌患者近期复发的影响

The influence of laparoscopic radical surgery for colon cancer on short-term recurrence of stage Ⅰ or Ⅱ colon cancer

目的:对比研究腹腔镜与开腹结肠癌根治术对患者术后近期结肠癌复发的影响,确定手术的安全性与有效性。方法:2010年1月至2012年10月的895例结肠癌患者,最终纳入62例腹腔镜结肠癌根治术与83例开腹结肠癌根治术作为队列研究,通过术后随访结局及GCC-mRNA、CEA分析,对比腹腔镜与开腹手术对结肠癌复发的影响。结果:两组患者入院时年龄、性别、BMI、肿瘤大小、分期、评分、病理类型及切除范围差异均无统计学意义。术后3年两组复发率差异无统计学意义,术后1年,腹腔镜组复发率明显低于开腹组(3.2%vs.14.5%,P=0.024);两组患者术后总生存率与死亡率差异亦无统计学意义,但术后1年,无瘤生存率腹腔镜组明显高于开腹组(93.5%vs.81.3%,P=0.040)。患者术后早期GCC-mRNA与CEA阳性率腹腔镜组显著低于开腹组。对患者术后1年的结肠癌复发进行单因素与多因素分析发现,与开腹手术相比,腹腔镜结肠癌根治术术后1年内可明显降低结肠癌的复发率。分期及有无氨基水杨酸类药物的应用都是术后复发的危险因素。结论:腹腔镜结肠癌根治术是安全的手术方式,较开腹手术可显著降低Ⅰ、Ⅱ期患者近期结肠癌复发率。

Objective：To compare the influence of laparoscopic and open radical surgery for colon cancer on short-term recurrence of colon cancer,in order to evaluate the safety and validity of operation. Methods ：The cohort study included 62 cases of laparoscopic and 83 cases of open colon cancer radical surgery from 895 patients with colon cancer from Jan. 2010 to Oct. 2012. The research aimed at comparing the effects of laparoscopic and open surgery on colon cancer recurrence by analyzing postoperative follow-up ending and GCC-mRNA ＆ CEA. Results：There were no obvious differences in age, sex, BMI, tumor size, stage, grade, pathological types and resection range between laparoscopy and open group. Postoperative 3-years recurrence of two groups was not significantly different, but 1-year recurrence rate of laparoscopic group was obviously lower than that of open operation （3.2% vs. 14.5% ,P = 0. 024）. There were no obvious differences in postoperative overall survival rate and mortality, but 1-year disease-free survival rate of laparoscopic group was obviously higher than that of open group （93.5% vs. 81.3%, P = 0. 040）. The positive rate of postoperative early-stage GCC-mRNA and CEA in laparoscopic group was significantly lower than that in open group. Univariable and multivariable analysis revealed that laparoscopic radical surgery for colon cancer could obviously reduce the cancer recurrence within 1 year. Stage and without amino salicylic acid drugs were independent risk factors of postoperative recurrence. Conclusions： Laparoscopic radical surgery for colon cancer is a safe and effective operation and can reduce short-term recurrence of stage I and II colon cancer compared with open surgery.