背景:微创手术(MIS),比如直肠癌的腹腔镜手术和机器人手术,在世界范围内执行。然而,对于临床上侵犯邻近器官的病例,MIS优于开放手术用于多内脏切除的优势的信息有限。
方法:这是一项回顾性倾向评分匹配研究,对2006年至2021年在东京大学医院接受根治性手术的T4b直肠癌连续临床患者进行研究。
结果:对69例接受多脏器切除的患者进行分析。33例患者接受了MIS(MIS组),36例接受开放手术(开放组)。每组匹配23例患者。2例接受MIS的患者需要转换(8.7%)。在MIS组和开放组中,分别有87.0%和91.3%的患者实现了R0切除,分别。MIS组的失血量明显减少(170vs.1130毫升;p<0.0001),Clavien-Dindo≥2级术后并发症较少(30.4%与65.2%;p=0.0170),术后住院时间较短(20vs.26天;p=0.0269)比开放组。3年癌症特异性生存率,无复发生存率,局部复发的累积发生率分别为75.7、35.9和13.9%,分别,在MIS组中,分别为84.5、45.4和27.1%,分别,在开放小组中,没有显着差异(分别为p=0.8462、0.4344和0.2976)。
结论:MIS比开放手术有几个短期优势,例如较低的并发症发生率,更快的恢复,住院时间缩短,在接受多内脏切除术的直肠癌患者中。
BACKGROUND: Minimally invasive surgery (MIS), such as laparoscopic and robotic surgery for rectal cancer, is performed worldwide. However, limited information is available on the advantages of MIS over open surgery for multivisceral resection for cases clinically invading adjacent organs.
METHODS: This was a retrospective propensity score-matching study of consecutive clinical T4b rectal cancer patients who underwent curative intent surgery between 2006 and 2021 at the University of Tokyo Hospital.
RESULTS: Sixty-nine patients who underwent multivisceral resection were analyzed. Thirty-three patients underwent MIS (the MIS group), while 36 underwent open surgery (the open group). Twenty-three patients were matched to each group. Conversion was required in 2 patients who underwent MIS (8.7%). R0 resection was achieved in 87.0% and 91.3% of patients in the MIS and open groups, respectively. The MIS group had significantly less blood loss (170 vs. 1130 mL; p < 0.0001), fewer Clavien-Dindo grade ≥ 2 postoperative complications (30.4% vs. 65.2%; p = 0.0170), and a shorter postoperative hospital stay (20 vs. 26 days; p = 0.0269) than the open group. The 3-year cancer-specific survival rate, relapse-free survival rate, and cumulative incidence of local recurrence were 75.7, 35.9, and 13.9%, respectively, in the MIS group and 84.5, 45.4, and 27.1%, respectively, in the open group, which were not significantly different (p = 0.8462, 0.4344, and 0.2976, respectively).
CONCLUSIONS: MIS had several short-term advantages over open surgery, such as lower complication rates, faster recovery, and a shorter hospital stay, in rectal cancer patients who underwent multivisceral resection.