腹腔镜手术与开放手术对Ⅱ期和Ⅲ期右侧结肠癌患者预后的影响

Effect of laparoscopic surgery in stage Ⅱ and Ⅲ right-sided colon cancer: a retrospective study

目的探讨开展腹腔镜手术对右侧结肠癌患者长期肿瘤学预后的影响。方法选取2013年1月-2014年12月在该院接受结肠癌根治术的200例患者纳入研究,根据入院时间将患者分为3组,第1组为未开展腹腔镜手术时入院;第2组为第一台腹腔镜手术至学习曲线未克服之前入院;第3组为学习曲线克服之后入院。随访跟踪患者预后情况。结果第1组、第2组和第3组患者3年总生存率(OS)和无病生存期(DFS)以及5年OS和DFS比较,差异均无统计学意义(P>0.05)。淋巴结浸润和术前癌胚抗原(CEA)是结肠癌患者3年DFS和5年DFS的危险因素。肿瘤分期、分化程度、淋巴结浸润是结肠癌患者3年OS和5年OS的危险因素。结论医院应该标准化手术操作流程,并给新进外科医生提供足够多的培训机会,尽早克服学习曲线。无论是技术还是肿瘤学方法,腹腔镜技术都被认为是安全和可行的,一旦掌握将成为结肠癌治疗的金标准。

Objective To evaluate the impact of introducing laparoscopic surgery on long-term oncological outcomes for right-sided colon cancer. Methods From Janunary 2013 to December 2014, 200 patients who underwent elective surgery with stage Ⅱ and Ⅲ right-sided colon cancer were analyzed. The period for group I referred back to the time when laparoscopic approach had not yet been introduced. The period for group Ⅱ was designated as the time when first laparoscopic approach for right colectomy was carried out until we overcame its learning curve. The period for group Ⅲ was the period after overcoming this learning curve. Results The 3-year overall survival rate(OS) and disease-free survival rate(DFS), and 5-year OS and DFS were not statistically significant between groups 1, 2 and 3(P > 0.05). Lymph node infiltration and preoperative CEA are risk factors for 3-year DFS and 5-year DFS in colon cancer patients. Tumor stage, degree of differentiation and lymph node invasion are risk factors for 3-year OS and 5-year OS in colon cancer patients. Conclusions Institutions should standardize their techniques and then provide fellowship training for newcomers of laparoscopic colon cancer surgery. This technique once mastered will become the gold standard approach to colon surgery as it is both safe and feasible considering the oncological and technical aspects.