同时性左侧结直肠癌肝转移完全腹腔镜同期切除的价值

The value of laparoscopic simultaneous resection for synchronous left-sided colorectal cancer liver metastases

目的探讨完全腹腔镜同期切除在治疗同时性左侧结直肠癌肝转移患者中的价值。方法回顾性分析2014年3月至2017年12月在复旦大学附属肿瘤医院行同期切除的同时性左侧结直肠癌肝转移患者临床资料。按手术方式分为全腹腔镜组、全开腹组及杂交术式组。比较三组间患者的术中情况、术后短期转归及长期生存。结果共96例患者纳入研究,其中全腹腔镜组29例,男性21例,女性8例,年龄(57.8±1.6)岁;全开腹组28例,男性18例,女性1例,年龄(57.3±2.0)岁;杂交手术组39例,男性27例,女性12例,年龄(55.3±1.8)岁。全开腹组的肝转移灶两叶分布比例高于全腹腔镜组及杂交手术组(均P<0.05),余临床基线特征三组间差异无统计学意义(均P>0.05)。全腹腔镜组、全开腹组及杂交术式组间手术时间分别为(241.5±12.9)min、(209.3±10.7)min及(234.9±12.4)min,中位出血量分别为200.0 ml、300.0 ml及200.0 ml,中位术后住院时间分别为8.0 d、9.0 d、9.0 d,差异均无统计学意义(均P>0.05)。全开腹组患者的开始排便时间长于其余两组患者,差异具有统计学意义(P<0.05)。在术后并发症发生率方面,全腹腔镜组、全开腹组及杂交术式组分别为31.0%(9/29)、39.3%(11/28)及35.9%(14/39),三组间差异无统计学意义(P>0.05)。全腹腔镜组、全开腹组及杂交术式组的1年总体生存率分别为93.0%、85.0%和94.0%,3年总体生存率分别为72.0%、81.0%、74.0%;1年无病生存率分别为70.0%、52.0%、55.0%,3年无病生存率分别为36.0%、30.0%和39.0%,差异均无统计学意义(P>0.05)。结论同时性左侧结直肠癌肝转移全腹腔镜同期切除在手术安全性及近期转归中略有优势,且不影响远期疗效。

Objective To investigate the value of total laparoscopic simultaneous resection for left-sided colorectal cancer(CRC)and synchronous liver metastases(SLM).Methods A retrospective analysis of the clinical data of patients with left-sided CRC and SLM who underwent simultaneous resection in the Shanghai Cancer Center,Fudan University from March 2014 to December 2017.The patients were divided into laparoscopy group,open surgery group and hybrid surgery group.The intraoperative information,postoperative short-term outcome and long-term survival were analyzed among the three groups.Results A total of 96 patients were enrolled.The total laparoscopic group enrolled 29 patients,including 21 males and 8 females,aged(57.8±1.6)years old;the open surgery group enrolled 28 patients,including 18 males and 10 females,aged(57.3±2.0)years old;39 cases were included in the hybrid surgery group,including 27 males and 12 females,aged(55.3±1.8)years old.The distribution ratio of the two lobes of liver metastases in the open surgery group was higher than that in the total laparoscopic group and hybrid surgery group(all P<0.05),and there was no significant difference in the other clinical baseline characteristics between the three groups(all P>0.05).In laparoscopy group,open surgery group and hybrid surgery group,the mean operative time was(241.5±12.9)min,(209.3±10.7)min and(234.9±12.4)min,respectively.The median intraoperative blood loss was 200.0 ml,300.0 ml and 200.0 ml,respectively.The median postoperative hospital stay was 8.0 days,9.0 days and 9.0 days,respectively.There were no statistical differences in these indicators(all P>0.05).The patients in the open surgery group had a longer initial defecation time than those in the other two groups(P<0.05).The incidence of postoperative complications was 31.0%(9/29),39.3%(11/28)and 35.9%(14/39),respectively,with no difference among the three groups(P>0.05).In laparoscopy group,open surgery group and hybrid surgery group,1-year overall survival were 93.0%,85.0%and 94.0%;3-year overall survival were 72.0%,81.0%and 74.0%,respectively(P>0.05).One-year disease free survival were 70.0%,52.0%and 55.0%;3-year disease free survival were 36.0%,30.0%and 39.0%,respectively(P>0.05).Conclusion Laparoscopic simultaneous resection for left-sided CRC and SLM shows slight advantages in the safety and short-term outcome,and does not affect the long-term survival.