结直肠癌伴同时性肝转移行腹腔镜同步切除手术的疗效:回顾性队列研究

Effect of simultaneous laparoscopic surgery in treatment of synchronous colorectal cancer liver metastasis:a retrospective cohort study

目的探讨腹腔镜同步切除的手术策略在结直肠癌伴同时性肝转移患者中的安全性和近远期疗效。方法回顾性收集2015年3月至2021年12月间于四川大学华西医院胃肠外科接受腹腔镜同步手术切除结直肠癌和肝转移灶的36例患者的临床资料,对围手术期情况、术后并发症和生存状况进行分析。结果36例患者均完成手术,手术时间(328.9±85.8)min,术中失血量100(50,150)mL,其中有4例(11.1%)术中输血;首次排气时间(2.9±0.8)d,首次进食时间(3.2±1.0)d,术后1~3 d平均视觉模拟量表评分(1.9±0.3)分,术后住院时间(6.8±4.3)d。术后30 d内5例(13.9%)出现并发症,均经保守治疗后痊愈,无严重并发症及死亡病例。中位随访24.7个月,15例(41.7%)复发转移,1例(2.8%)死亡。术后1、2、3年无病生存率分别为89.8%、55.0%、29.2%,1、2、3年总体生存率分别为100%、100%、87.5%。新辅助治疗组与未行新辅助治疗组患者的无病生存(χ^(2)=1.675,P=0.196)和总体生存(χ^(2)=0.600,P=0.439)比较差异均无统计学意义。结论本研究初步结果表明,对结直肠癌伴同时性肝转移患者实施腔镜同步切除的手术策略安全可行,手术切口小、术中失血量少、术后恢复快、并发症发生率低,生存获益满意,未来亟需更多高质量研究进一步证实此种手术策略的临床安全性与可行性。

Objective To explore the security and feasibility of simultaneous laparoscopic surgery for synchronous colorectal cancer liver metastasis(SCRLM).Method The data of 36 patients underwent simultaneous surgery for SCRLM in the Division of Gastrointestinal Surgery,Department of General Surgery,West China Hospital of Sichuan University from March 2015 to December 2021 were retrospectively collected,and the perioperative outcomes,postoperative morbidity and survival were analyzed.Results The surgical procedure of all 36 enrolled patients were accomplished.The operation time was(328.9±85.8)min.The intraoperative blood loss was 100(50,150)mL and 4 cases(11.1%)needed intraoperative transfusion.The time to first flatus was(2.9±0.8)d and the time to liquid diet was(3.2±1.0)d.The average postoperative VAS score was 1.9±0.3.The postoperative length of stay was(6.8±4.3)d,5(13.9%)cases developed postoperative complications,which were cured by conservative treatment.No severe complications and death occurred within 30 days after surgery.After a median follow-up of 24.7 months,15 cases(41.7%)experienced recurrence or metastasis and 1 case(2.8%)died.The 1-,2-and 3-year disease-free survival rates were 89.8%,55.0%,29.2%,respectively.The 1-,2-and 3-year overall survival rates were 100.0%,100.0%,87.5%,respectively.There was no significant differences in disease-free survival rates(χ^(2)=1.675,P=0.196)and OS(χ^(2)=0.600,P=0.439)between patients with(n=26)or without(n=10)neoadjuvant.Conclusions Simultaneous laparoscopic surgery seems to be a secure and feasible strategy for patients with SCRLM,with considerable survival benefits and short-term outcomes including small incision,little bleeding,quick recovery and low complication rate.More high-quality clinical studies are desirable in the future to further confirm the efficacy and safety of this operation.