Risk Factors for Predicting Conversion in Laparoscopic Colorectal Cancer Surgery

腹腔鏡大腸直腸癌手術術中轉換為開腹式手術的原因分析

林恩光(En-Kwang Lin) ； 林楨國(Jen-Kou Lin) ； 林資琛(Tzu-Chen Lin) ； 陳維熊(Wei-Chone Chen) ； 姜正愷(Jeng-Kai Jiang) ； 王煥昇(Huann-Sheng Wang) ； 張世慶(Shih-Ching Chang) ； 藍苑慈(Yuan-Tzu Lan) ； 林春吉(Chun-Chi Lin) ； 楊純豪(Shung-Haur Yang)

《中華民國大腸直腸外科醫學會雜誌》 23卷2期 (2012/06) Pp. 57-63

https://doi.org/10.6312/SCRSTW.2012.23(2).10022

摘要

目的 了解本院腹腔鏡大腸直腸癌手術術中轉換為開腹式手術的原因。方法 我們統計自2007年7月到2010年12月，將所有接受單一醫師腹腔鏡大腸直腸癌手術的病患，與術中轉換為開腹式手術的病患進行分析。期能找出轉換為開腹式手術之原因。結果 共有280位病患接受腹腔鏡大腸直腸癌手術，其中有16位在術中轉換為開腹式手術，比率為5.7%。在單變異分析中，身體質量指數（BMI）值超過27kg/m^2（輕度肥胖以上）、T4病灶、手術例為20例之前等三項因子達到顯著差異；而在多變異分析中，身體質量指數（BMI）值超過27kg/m^2（輕度肥胖以上）、T4病灶、手術例為20例之前等三項因子仍達到顯著差異。其他如性別、年齡、腫瘤位置、腫瘤大小、TMN分期、術前接受輔助性治療與否、術前血清白蛋白、CEA的數值，都不會對腹腔鏡術式的完成造成影響。結論 根據本院的資料統計，在單一資深大腸直腸專科手術醫師，腹腔鏡大腸直腸癌手術轉為開腹式手術的比率為5.7%。身體質量指數（BMI）值超過27kg/m^2（輕度肥胖以上）、T4病灶、手術例為20例之前是危險因子。這些訊息將能對以後的術前評估有所幫助。

關鍵字

腹腔鏡 ； 大腸直腸癌 ； 轉換

並列摘要

Purpose. To identify the risk factors for malignancy-related conversion in laparoscopic colorectal resections.Methods. We retrospectively analyzed all laparoscopic colorectal cancer surgeries performed between July 2007 and December 2010 by 1 specialist to investigate the risk factors for conversion.Results. Of the 280 laparoscopic colorectal cancer surgeries, 16 were converted to open surgery, an overall conversion rate of 5.7%. Univariate analysis revealed that a body mass index (BMI) of ＞ 27 kg/m^2, T4 lesions, and being among the first 20 operations performed by the surgeon were factors significantly associated with conversion. Multivariate analysis also showed that a BMI of ＞ 27 kg/m^2 (p = 0.025), T4 lesions (p = 0.001), and being among the first 20 operations (p = 0.001) were independent factors of conversion. Other factors, such as gender, age, tumor location, tumor size, TMN staging, any metastasis, neo-adjuvant treatment, pre-op carcinoembryonic antigen (CEA) level, and albumin level, showed no influence on the likelihood for conversion. In our study, the reasons for conversion fell into 3 categories: (1) patient- related factors, such as obesity, adhesion, and enlarged ovaries, (2) disease-related factors, including tumor invasion of adjacent organs such as the bladder, small bowel, and abdominal wall, and (3) surgery-related factors such as uncontrollable bleeding, vessel disruption, and difficult localization of the tumor.Conclusion. ABMI exceeding 27 kg/m^2, T4 lesions, and being among the first 20 cases (the learning curve) all correlated with conversion risk in this study. These factors should be taken into consideration during the preoperative evaluation.

並列關鍵字

Laparoscopic surgery ； Colorectal cancer ； Conversion