Laparoscopic-assisted Versus Open Surgery for Rectal Cancer

直腸癌在腹腔鏡手術和傳統剖腹手術的比較

江驊哲(Hua-Che Chiang) ； 陳自諒(Willian Tzu-Liang Chen) ； 吳思穎(Christina Wu)

《中華民國大腸直腸外科醫學會雜誌》 21卷2期 (2010/06) Pp. 79-86

https://doi.org/10.6312/SCRSTW.2010.21(2).09829

摘要

Purpose. The aim of this study was to compare the short-term outcome for consecutive patients undergoing either laparoscopic or open rectal resection for cancer in a single specialized institution.
Methods. All patients with rectal cancer admitted to our institution from September 2006 to August 2008 were included in the study. Patients who underwent emergency operation were excluded. Patients were given the option of laparoscopic or open colectomy and asked to choose after thorough explanation of the pros and cons of each procedure. Patients who had clinical T3 stage cancer or positive lymph nodes were treated with preoperative chemoradiotherapy. The same surgical team was used for all surgical procedures and all patients were prospectively followed for a minimum period of 6 months, in accordance with NCCN Clinical Guidelines in Oncology.
Results. Of the 151 consecutive patients in the study, 76 chose to undergo laparoscopic colectomies while 75 decided on open surgery. The procedures included low anterior resection with staple anastomosis for 99 patients (laparoscopy/convention: 45/54), abdominoperineal resection for 13 patients (laparoscopy/convention: 9/4), Hartmann's procedure for 12 patients (laparoscopy/convention: 4/8), and low anterior resection with hand-sewn transanal coloanal anastomosis for 27 patients (laparoscopy/convention: 18/9). Conversion to an open procedure occurred for 7 patients (9.2%). Postoperative complications developed in 18 patients in laproscopy group and 14 patients in the conventional group. The length of hospital stay for the conventional group was significantly longer than that of laparoscopic group (12 vs 10 days; p＜0.001). Furthermore, laparoscopic surgery offers decreased rate of blood loss (145 vs 218 cc; p＜0.001), but higher operative time compared to open surgery (234 vs 181 minutes; p＜0.001).
Conclusion. Laparoscopic resection is a safe and feasible method of operation for rectal cancer. It does not affect the early surgical oncological outcome, such as length of specimen removed, distal margin, and number of lymph node identified. It also offers decreased rate of blood loss and shorter lengths of hospital stay. However, longer follow-up duration and larger sample sizes will be needed to reveal definitive long-term results of laparoscopic-assisted surgery.

關鍵字

腹腔鏡手術 ； 短期預後 ； 直腸癌

並列摘要

Purpose. The aim of this study was to compare the short-term outcome for consecutive patients undergoing either laparoscopic or open rectal resection for cancer in a single specialized institution.
Methods. All patients with rectal cancer admitted to our institution from September 2006 to August 2008 were included in the study. Patients who underwent emergency operation were excluded. Patients were given the option of laparoscopic or open colectomy and asked to choose after thorough explanation of the pros and cons of each procedure. Patients who had clinical T3 stage cancer or positive lymph nodes were treated with preoperative chemoradiotherapy. The same surgical team was used for all surgical procedures and all patients were prospectively followed for a minimum period of 6 months, in accordance with NCCN Clinical Guidelines in Oncology.
Results. Of the 151 consecutive patients in the study, 76 chose to undergo laparoscopic colectomies while 75 decided on open surgery. The procedures included low anterior resection with staple anastomosis for 99 patients (laparoscopy/convention: 45/54), abdominoperineal resection for 13 patients (laparoscopy/convention: 9/4), Hartmann's procedure for 12 patients (laparoscopy/convention: 4/8), and low anterior resection with hand-sewn transanal coloanal anastomosis for 27 patients (laparoscopy/convention: 18/9). Conversion to an open procedure occurred for 7 patients (9.2%). Postoperative complications developed in 18 patients in laproscopy group and 14 patients in the conventional group. The length of hospital stay for the conventional group was significantly longer than that of laparoscopic group (12 vs 10 days; p＜0.001). Furthermore, laparoscopic surgery offers decreased rate of blood loss (145 vs 218 cc; p＜0.001), but higher operative time compared to open surgery (234 vs 181 minutes; p＜0.001).
Conclusion. Laparoscopic resection is a safe and feasible method of operation for rectal cancer. It does not affect the early surgical oncological outcome, such as length of specimen removed, distal margin, and number of lymph node identified. It also offers decreased rate of blood loss and shorter lengths of hospital stay. However, longer follow-up duration and larger sample sizes will be needed to reveal definitive long-term results of laparoscopic-assisted surgery.

並列關鍵字

Laparoscopic surgery ； Short-term outcome ； Rectal cancer