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Abstract：
BACKGROUND: A laparoscopic approach to right colectomies for emergency right colon cancers is under investigation. This study compares perioperative and oncological long-term outcomes of right colon cancers undergoing laparoscopic or open emergency resections and identifies risk factors for survival.
METHODS: Patients were identified from a prospectively maintained institutional database between 2009 and 2019. Demographics, clinicopathological features, recurrence, and survival were investigated. Cox regression analysis was performed for risk factor analysis.
RESULTS: A total of 202 right colectomies (114 open and 88 laparoscopic) were included. ASA III-IV was higher in the open group. The conversion rate was 14.8%. Laparoscopic surgery was significantly longer (156 vs. 203 min, p < 0.001); pTNM staging did not differ. Laparoscopy was associated with higher lymph node yield, and showed better resection clearance (R0, 78.9 vs. 87.5%, p = 0.049) and shorter postoperative stay (12.5 vs. 8.0 days, p < 0.001). Complication rates and grade were similar. The median length of follow-up was significantly higher in the laparoscopic group (20.5 vs. 33.5 months, p < 0.001). Recurrences were similar (34.2 vs. 36.4%). Open surgery had lower five-year overall survival (OS, 27.1 vs. 51.7%, p = 0.001). Five-year disease-free survival was similar (DFS, 55.8 vs. 56.5%). Surgical approach, pN, pM, retrieved LNs, R stage, and complication severity were risk factors for OS upon multivariate analysis. Pathological N stage and R stage were risk factors for DFS upon multivariate analysis.
CONCLUSIONS: A laparoscopic approach to right colon cancers in an emergency setting is safe in terms of perioperative and long-term oncological outcomes. Randomized control trials are required to further investigate these results.
METHODS: Patients were identified from a prospectively maintained institutional database between 2009 and 2019. Demographics, clinicopathological features, recurrence, and survival were investigated. Cox regression analysis was performed for risk factor analysis.
RESULTS: A total of 202 right colectomies (114 open and 88 laparoscopic) were included. ASA III-IV was higher in the open group. The conversion rate was 14.8%. Laparoscopic surgery was significantly longer (156 vs. 203 min, p < 0.001); pTNM staging did not differ. Laparoscopy was associated with higher lymph node yield, and showed better resection clearance (R0, 78.9 vs. 87.5%, p = 0.049) and shorter postoperative stay (12.5 vs. 8.0 days, p < 0.001). Complication rates and grade were similar. The median length of follow-up was significantly higher in the laparoscopic group (20.5 vs. 33.5 months, p < 0.001). Recurrences were similar (34.2 vs. 36.4%). Open surgery had lower five-year overall survival (OS, 27.1 vs. 51.7%, p = 0.001). Five-year disease-free survival was similar (DFS, 55.8 vs. 56.5%). Surgical approach, pN, pM, retrieved LNs, R stage, and complication severity were risk factors for OS upon multivariate analysis. Pathological N stage and R stage were risk factors for DFS upon multivariate analysis.
CONCLUSIONS: A laparoscopic approach to right colon cancers in an emergency setting is safe in terms of perioperative and long-term oncological outcomes. Randomized control trials are required to further investigate these results.
摘要：
背景：目前正在研究一种腹腔镜右结肠切除术治疗急性右半结肠癌的方法。这项研究比较了接受腹腔镜或开腹急诊切除术的右结肠癌的围手术期和肿瘤学长期结局，并确定了生存的危险因素。
方法：从2009年至2019年前瞻性维护的机构数据库中确定患者。人口统计,临床病理特征，复发,和生存进行了调查。Cox回归分析进行危险因素分析。
结果：共纳入202例右结肠切除术（114例开腹和88例腹腔镜）。ASAIII-IV在开放组中较高。转化率为14.8%。腹腔镜手术时间明显延长（156vs.203分钟,p<0.001)；pTNM分期没有差异。腹腔镜检查与较高的淋巴结产量相关，并显示出更好的切除清除（R0，78.9vs.87.5%,p=0.049）和更短的术后住院时间（12.5vs.8.0天,p<0.001)。并发症发生率和等级相似。腹腔镜组的中位随访时间明显较高（20.5vs.33.5个月，p<0.001)。复发相似（34.2与36.4%）。开放手术的五年总生存率较低(OS，27.1vs.51.7%,p=0.001)。五年无病生存率相似(DFS，55.8vs.56.5%）。手术方法,pN,pM,检索到的LN，R阶段,根据多变量分析，并发症严重程度是OS的危险因素。多因素分析显示病理性N期和R期是DFS的危险因素。
结论：就围手术期和长期肿瘤学结果而言，在紧急情况下腹腔镜治疗右半结肠癌是安全的。需要随机对照试验来进一步研究这些结果。
方法：从2009年至2019年前瞻性维护的机构数据库中确定患者。人口统计,临床病理特征，复发,和生存进行了调查。Cox回归分析进行危险因素分析。
结果：共纳入202例右结肠切除术（114例开腹和88例腹腔镜）。ASAIII-IV在开放组中较高。转化率为14.8%。腹腔镜手术时间明显延长（156vs.203分钟,p<0.001)；pTNM分期没有差异。腹腔镜检查与较高的淋巴结产量相关，并显示出更好的切除清除（R0，78.9vs.87.5%,p=0.049）和更短的术后住院时间（12.5vs.8.0天,p<0.001)。并发症发生率和等级相似。腹腔镜组的中位随访时间明显较高（20.5vs.33.5个月，p<0.001)。复发相似（34.2与36.4%）。开放手术的五年总生存率较低(OS，27.1vs.51.7%,p=0.001)。五年无病生存率相似(DFS，55.8vs.56.5%）。手术方法,pN,pM,检索到的LN，R阶段,根据多变量分析，并发症严重程度是OS的危险因素。多因素分析显示病理性N期和R期是DFS的危险因素。
结论：就围手术期和长期肿瘤学结果而言，在紧急情况下腹腔镜治疗右半结肠癌是安全的。需要随机对照试验来进一步研究这些结果。
