腹腔镜同期手术在同时性结直肠癌肝转移中的应用

Laparoscopic simultaneous resection of synchronous colorectal cancer liver metastases

目的探讨腹腔镜同期手术策略在同时性结直肠癌肝转移中应用的安全性和有效性。方法回顾性分析2009年1月到2019年12月在北京大学第三医院普通外科接受根治性手术的121例同时性结直肠癌肝转移患者资料,根据手术方式分为腹腔镜组和开腹组,统计分析两组患者的一般资料、手术资料、术后并发症情况及随访情况。结果腹腔镜组79例患者,其中女性30例,男性49例,平均年龄61.5岁;开腹组42例患者,其中女性15例,男性27例,平均年龄63.2岁。两组人口学特点、结直肠原发肿瘤部位、基因检测情况、肝转移灶大小、多发转移灶比例、术前肿瘤标志物水平和新辅助化疗比例差异均无统计学意义(P>0.05)。腹腔镜组术后并发症发生率为15.2%(12/79),开腹组为23.8%(10/42),两组差异无统计学意义(P>0.05)。腹腔镜组3年、5年总体生存率分别为52.9%、44.4%,开腹组分别为42.5%、23.0%,两组差异无统计学意义(P>0.05)。腹腔镜组1年、3年无病生存率分别为50.6%、41.2%,开腹组分别为44.7%、19.4%,两组差异无统计学意义(P>0.05)。结论腹腔镜同期手术策略应用于同时性结直肠癌肝转移安全有效,腹腔镜手术与开腹手术相比不增加并发症,具有相同的肿瘤学效果。

Objective This research was designed to investigate the safety and efficiency of laparoscopic simultaneous resection in the treatment of synchronous colorectal cancer liver metastases(sCRLM).Methods From January 2009 to December 2019,121 patients diagnosed as sCRLM received radical resection in Peking University Third Hospital were included in the research.According to the surgery approaches,the patients were divided into laparoscopic surgery group and open surgery group.Statistical analysis of general patient data,surgical data,postoperative complications and follow-up of the two groups of patients.Results There were 79 cases in the laparoscopic surgery group including 30 females and 49 males,and the average age was 61.5 years.There were 42 cases in the open surgery group including 15 females and 27 males,and the average age was 63.2 years.There were no significant differences in the preoperative demographic characteristics,the location of primary tumor,gene status,the size of liver metastases,the proportion of multiple liver metastases,the level of tumor markers and the proportion of neoadjuvant chemotherapy between laparoscopic surgery group and the open surgery group(P>0.05).The complication rate was 15.2%(12/79)in the laparoscopic surgery group and 23.8%(10/42)in the open surgery group.There were no significant differences between the two groups(P>0.05).The 3-year and 5-year survival rates in laparoscopic surgery group were 52.9%and 44.4%,which were 42.5%and 23.0%respectively in open surgery group.There were no significant differences between the two groups(P>0.05).The 1-year and 3-year disease-free survival rate in laparoscopic surgery group were 50.6%and 41.2%,which were 44.7%and 19.4%respectively in open surgery group.There were no significant differences between the two groups(P>0.05).Conclusions Laparoscopic simultaneous resection was safe and feasible for patients with sCRLM.Comparing with the open surgery,the laparoscopic surgeries had similar incidence of perioperative complications and long-term oncological efficiency.