- 期刊
Laparoscopic Surgery and MIS for Colorectal Cancer in Taiwan
台灣大腸直腸癌微創腹腔鏡手術的現況
摘要
台灣的第一例腹腔鏡大腸直腸手術為北榮陳維熊教授執行之慢性盲腸憩室炎的右側結腸切除術。在當時，此種新手術技巧的投資報酬率甚低，且對大腸直腸惡性腫瘤的治療效果亦不明。由於當時腹腔鏡大腸直腸癌手術的技巧剛開始萌芽，更遑論應用腹腔鏡技巧切除晚期的大腸癌。無可諱言的，腹腔鏡手術比傳統剖腹手術，必須經過較陡的學習曲線。直到公元1997年引進諧波刀（Harmonic Scalpel）、新手術技巧的研發、腹腔鏡影像系統本身的進步，使有志於此領域的大腸直腸外科醫師受到莫大鼓舞。在公元2004年，美國Mayo Clinic的Dr. Heidi Nelson所領導多醫學中心之隨機前瞻性研究成果在新英格蘭雜誌發表，並率先指出腹腔鏡手術在大腸癌（colon cancer）的治療成果是與傳統剖腹手術相同的，而我們也在公元2007年發表同樣的結果。目前台大醫院大腸直腸外科以腹腔鏡切除的大腸直腸癌約佔所有病例數的80%，相較於台灣所有病例平均只有約10~15%以腹腔鏡切除，顯然是較高的。整個癌症的治療目前朝向個人化、人性化醫療。腹腔鏡手術使得病人術後較快恢復，手術過程免疫壓抑程度較低，因此目前已成為大腸直腸癌手術的趨勢。然而，目前尚有一些極待開發的新領域，例如晚期右側大腸癌的廣泛淋巴腺廓清、低位晚期直腸癌的骨盆外側淋巴腺廓清與主動脈旁淋巴腺廓清，合併鄰近臟器侵犯之T4大腸直腸癌的腹腔鏡手術，以及腹腔鏡腹膜切除手術（peritonectomy）等等，均值得做進一步的探討。
並列摘要
In Taiwan, the first case of laparoscopic resection of colon cancer was performed in December, 1993 for a T2N0M0-stage sigmoid cancer. At that time, the cost-effectiveness of this novel surgical technique was low and the efficacy of laparoscopic approach for colorectal cancer was still unknown, and to learn and perform laparoscopic colorectal surgery were both very challenging. It was not until the emergence of the Harmonic Scalpel in 1997 that provided efficient laparoscopic dissection over anatomical boundaries such as the omentum, mesentery, and even retroperitoneal areole tissues was provided, and with the introduction of medial-to-lateral laparoscopic no-touch isolation technique, fledgling laparoscopic colorectal surgeons were greatly encouraged to perform this novel technique. In 2000, an annual training workshop on laparoscopic technique for colorectal surgeons was commenced in Taiwan. Remarkably, by 2003, more than 500 cases of laparoscopic resection had been performed in National Taiwan University Hospital. From then on, the laparoscopic skill was reckoned as mature, and actually, laparoscopic approaches were widely applied to all of the colorectal diseases that previously had been treated by traditional open surgery. Yet a randomized trial regarding laparoscopic approach for rectal cancer is still lacking. Currently, laparoscopic resection of colorectal cancer represents around 80 percent of the personal series in National Taiwan University Hospital, as compared to approximately 10~15 percent of all cases of colorectal cancer in Taiwan. Currently, some new laparoscopic surgical frontiers still need to be further developed, such as radical lymph node dissection over the surgical trunk of the right colon, the lateral pelvis lymphatic basin of lower rectal cancers, and para-aortic lymph nodes. Moreover, we also desire to extend the surgical indication for laparoscopic approach to T4 colorectal cancer and pelvic peritonectomy for rectosigmoid cancer with limited peritoneal dissemination.