直肠癌患者新辅助放化疗后腹腔镜与开腹侧方淋巴结清扫术的近中期预后疗效分析

Short-term outcomes and medium-term prognosis of laparoscopic and open lateral pelvic lymph node dissection after neoadjuvant chemoradiotherapy in rectal cancer patients

目的比较新辅助放化疗(nCRT)后开腹与腹腔镜侧方淋巴结清扫术(LPLND)的近期疗效与中期肿瘤学治疗结局。方法回顾性收集分析2011年1月至2019年12月期间在两家医院nCRT后行全直肠系膜切除术(TME)+LPLND的139例直肠癌患者的临床病例资料,按照手术入路将患者分为腹腔镜组(n=122)和开腹组(n=17)。采用倾向得分匹配法对协变量进行1:1匹配,最终腹腔镜组与开腹组各纳入16例患者。t检验或卡方检验比较两组患者手术结果、术后并发症、病理结果。采用Kaplan-Meier法进行生存曲线绘制,采用Long-Rank法进行生存时间比较,将有意义的因素纳人COX比例风险回归模型进行多因素预后分析。P<0.05为差异有统计学意义。结果匹配后,腹腔镜组患者术后出血量降低(100ml vs.300ml,P=0.017)、术后住院时间缩短(7dus.15d,P=0.011)、LPLN清扫数量(9枚vs.7枚,P=0.003)与总淋巴结清扫数量(25枚vs.20枚,P=0.033)明显增多。生存预后方面,腹腔镜组与开腹组的3年总体生存率(92.3%vs.75.2%,P=0.929)与无瘤生存率(71.3%vs.63.6%,P=0.976)差异无统计学意义。结论nCRT后行腹腔镜LPLND是安全可行的,具有创伤小、恢复快、淋巴结清扫彻底等短期优势。同时,有着与开腹LPLND相似的中期肿瘤学治疗结局。

Objective To compare the short-term and medium-term outcomes of neoadjuvant chemoradiotherapy(nCRT)followed by open and laparoscopic lateral lymph node dissection(LPLND).MethodsThe clinicopathologic data of 139 patients with rectal cancer who underwent total mesenterectomy(TME)+LPLND after nCRT in two hospitals from January 2010 to June 2022 were retrospectively collected and analyzed.The patients were divided into laparoscopy group and laparotomy group according to the surgical approach.Propensity score matching method was used to match the covariables 1:1,and finally 16 patients were included in the laparoscopy group and the laparotomy group respectively.t test or X test were used to compare the surgical results',postoperative complications and pathological results between the two groups.Kaplan-Meier method was used to draw the survival curve,the Long-Rank method was used to compare the survival time,and the significant factors were included in the COX proportional risk regression model for multivariate prognostic analysisP.<0.05 was considered statistically significant.ResultsAnd when we match,In the laparoscopic group,postoperative blood loss was decreased(100 us.300 ml,P=0.017),postoperative hospital stay was shortened(7 vs.15 d,P=0.011),the number of LPLN dissection(9 vs.7,P=0.003)and total lymph node dissection(25 vs.20,P=0.033)increased significantly.In terms of survival prognosis,there was no significant difference in 3-year overall survival rate(92.3%vs.75.2%,P=0.929)and tumor-free survival rate(71.3%vs.63.6%,P=0.976)between the laparoscopic and open groups.ConclusionLaparoscopic LPLND after nCRT is safe and feasible,with short term advantages such as less trauma,quick recovery and thorough lymph node dissection.At the same time,it has a similar medium-term oncology outcome to open LPLND.