Surgical Strategy for Synchronous Colorectal Neoplasia: Lparoscopica Resection is Feasible

以腹腔鏡手術來治療同時存在之多發性大腸直腸腫瘤

黃凱傑(Kai-Chieh Huang) ； 陳怡君(Yi-Jyun Chen) ； 梁金銅(Jin-Tung Liang)

《中華民國大腸直腸外科醫學會雜誌》 26卷4期 (2015/12) Pp. 123-128

https://doi.org/10.6312/SCRSTW.2015.26(4).10313

摘要

背景與目的：隨著診斷技術的進步，臨床上有越來越多的同時存在之多發性大腸直腸腫瘤（SCRN）在手術前被診斷出來。雖然SCRN在臨床上被確認已有一段時間，但是其臨床特徵、診斷方式、治療策略、甚至預後如何都還未完全被瞭解。腹腔鏡手術應用在大腸直腸手術的優勢，無論是處理良性症狀或是惡性腫瘤都已經被廣泛的確定，但腹腔鏡手術使用在SCRN病患身上的經驗尚未被討論。本篇文章的目的，就是要收集並分析腹腔鏡對於SCRN治療效果以及其相關併發症，來總結腹腔鏡手術是否適用於治療SCRN病患。方法：我們以回朔性統計從2004年到2012年，其中診斷為SCRN的病患並用腹腔鏡手術切除大腸直腸癌共32位，所收集的每個病患的多顆腫瘤中最少有一顆為惡性，其中同時診斷出有兩個惡性腫瘤的有19位。而病患併存的良性腫瘤皆經過評估不適合由內視鏡切除，所以與惡性腫瘤同時用腹腔鏡手術切除。結果：在這9年期間有32名病患被診斷為SCRN並且接受腹腔鏡手術，其中平均年齡為72歲，男女比例為3:1，BMI（weight/height2, kg/m2）為23.3，家族病史中有大腸癌相關的只有5（15%），大部分的病人腫瘤數目都是兩顆，有4位病患有三顆腫瘤，3位病患有四顆腫瘤。手術部分平均手術時間為309分鐘，失血量為239 ml，術式的種類依據切除的部位分為單一吻合的切除13例，而有兩處吻合的共有12例，全部術式裡有術後造口的共8例，包含了3例永久人工肛門，預防性人工肛門有5例。手術30天內的短期追蹤裡顯示：排氣天數為4天，住院天數為14天，術後立即的併發症術目為6例（18.7%）。長期追蹤超過一年的有25例，其中一例在術後28個月因為化療併發症死亡，3例有遠處復發的病史，而有1位病人在術後46個月時發現有metachronous colon cancer，經過在切除後目前追蹤76個月都沒有再復發或是轉移。結論：用腹腔鏡手術來治療SCRN病患因為手術範圍擴大，手術時間明顯會比單一大腸腫瘤要長，但在術後併發症以及短期追蹤結果的比較下，並沒有比較差。而優勢的部分就是會比傳統剖腹的方式傷口小，疼痛少，因此，以腹腔鏡手術來治療SCRN的病患是一個適當的選擇。

關鍵字

同步發生的大腸直腸癌 ； 腹腔鏡手術

並列摘要

Background/Aims. New diagnostic technologies have led to a greater chance of preoperative detection of synchronous neoplasms in patients undergoing surgical resection of colorectal tumors. Although synchronous colorectal neoplasia (SCRN) has been known for years, clinical signs and symptoms, optimal diagnostic methods and treatment strategy, and prognosis remain unclear. The benefits of laparoscopic colon resection have been widely reported, and several reports of laparoscopic resection in cases of SCRN have also been published. However, larger series will be needed to verify the advantage of laparoscopic resection for patients with SCRN. Methods. Among 1,023 retrospectively identified patients who underwent laparoscopic colon resection for colorectal cancer at our institution between 2004 and 2012, 32 (3.1%) had multiple primary colorectal neoplasms. There was at least one malignant tumor in all 32 cases, and 19 patients had two malignant tumors. In patients with synchronous adenomas who were not candidates for endoscopic mucosal resection or submucosal dissection of the benign lesions, benign and malignant lesions were resected simultaneously during laparoscopic colectomy. Results. Twenty-one of the 32 patients had stage I or II tumors and 11 had stage III or IV tumors. The mean index tumor size was 4.4 cm, and the most frequent locations were the right colon and the rectum. Secondary tumors were evenly distributed in all locations. The mean operation time was 309 minutes, and blood loss was approximately 250 mL. Among surgical strategies, double anastomosis was performed in 12 patients, a permanent stoma was created in 3 patients, and 5 patients had a temporary stoma. In terms of immediate outcomes, time to flatus was 4 days and hospital stay was 14 days. Six patients had postoperative complications but there was no surgical mortality. Conclusion. Laparoscopic surgery had acceptable short-term outcomes in patients with SCRN. The main advantages of laparoscopic surgery are smaller incisions and reduced postoperative pain. Despite longer operation times due to the extended dissection field, laparoscopic surgery was a feasible surgical strategy for patients with SCRN.

並列關鍵字

Synchronous colorectal carcinoma ； Laparoscopic surgery

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