Three-dimensional vs. Two-dimensional Laparoscopic Colectomy and Protectomy for Colon Cancer and Rectal Cancer: A Single Center Experience

3D腹腔鏡及2D腹腔鏡對於大腸癌手術的術後結果分析比較：來自一家醫學中心的臨床經驗

秋清華(Ching-Hua Chiu) ； 許詔文(Chao-Wen Hsu) ； 張敏琪(Min-Chi Chang) ； 林健源(Lin-Chien Yuan) ； 朱炳騰(Ping-Teng Chu) ； 李明泓(Ming-Hung Lee) ； 陳禹勳(Yu-Hsun Chen) ； 吳志謙(Chih-Chien Wu) ； 王永昌(Wang-Yung Chang) ； 王瑞和(Jiu-Ho Wang)

《中華民國大腸直腸外科醫學會雜誌》 33卷1期 (2022/03) Pp. 11-18

https://doi.org/10.6312/SCRSTW.202203_33(1).11020

摘要

Purpose. Previous studies have shown several advantages of laparoscopic colectomy over open surgery.With the evolution of the three-dimensional laparoscopy image system, many two-dimensional laparoscopic colectomy surgeries were replaced by three-dimensional laparoscopy. Although some studies have compared the outcomes of three-dimensional vs. two-dimensional laparoscopic colectomy and protectomy in colon cancer and rectal cancer, the results of long-term follow-up are lacking. We analyzed the long-term oncological outcomes of three-dimensional vs. two-dimensional laparoscopic surgery for colon cancer and rectal cancer. Methods. We retrieved the data of patients who underwent laparoscopic colectomy or protectomy at a single medical center (Kaohsiung Veterans General Hospital) between November 2017 and November 2018. Surgical outcomes, including intraoperative parameters, postoperative outcomes, pathological characteristics, and 3-year survival rate, were compared between the three-dimensional (n = 63) and two-dimensional laparoscopy groups (n = 63). Results. The duration of surgery was significantly shorter in the three-dimensional group than in the two-dimensional group (257 ± 99 vs. 206 ± 57 min, p = 0.002). There was no significant difference in postoperative outcomes. Time to pass the first flatus was lesser in the three-dimensional group than in the two-dimensional group (3 ± 1 vs. 4 ± 1, p = 0.053); however, there was no significant difference. The rate of complications was similar in both groups (7.94%, 5/63). The number of harvested lymph nodes was higher in the three-dimensional than in the two-dimensional group (24 ± 10 vs. 22 ± 8, p = 0.055); however, the difference was not statistically significant. The survival rates in the three-dimensional vs. twodimensional laparoscopy group were not significantly different (diseasefree survival rate, 85.7% vs. 73.0%, p = 0.066; overall survival rate 88.9% vs. 82.5%, p = 0.275, respectively). Conclusions. Our study showed that three-dimensional laparoscopy reduces the operative time compared to two-dimensional laparoscopy in colectomy and protectomy surgery. Larger, prospective, randomized, controlled studies are necessary to evaluate whether three-dimensional laparoscopy has better oncological outcomes and long-term survival rate in laparoscopic colon cancer and rectal cancer surgery.

關鍵字

3-dimensional (3D) image system ； Laparoscopic colon surgery ； Long-term outcomes

並列摘要

背景：之前有許多研究比較3D腹腔鏡大腸癌手術相對2D的術後結果，但是缺乏長期的術後追蹤，這篇研究的目的就是要分析3D腹腔鏡大腸癌手術相對2D腹腔鏡的長期術後結果。方法：我們收案自己醫院接受腹腔鏡大腸癌手術的病人，分成3D腹腔鏡跟2D腹腔鏡兩個組別，每一組各有63人，並從兩組病人比較術後結果及3年的存活率。結果：3D組的手術時間明顯短於2D組（257 vs. 206 min, p=0.002），術後結果只有此項有顯著差異，3年追蹤的無病存活率（85.7% vs. 73.0%, p=0.066）及整體存活率（88.9% vs. 82.5%, p=0.275）在3D組的結果都比較高，然而這些也都沒有顯著差異。結論：我們的研究發現3D腹腔鏡相對於2D腹腔鏡在大腸癌手術確實可以降低手術時間，未來還需要更多病例的前瞻性研究來分析3D腹腔鏡的術後結果及長期存活率。

並列關鍵字

3D腹腔鏡 ； 2D腹腔鏡 ； 大腸癌及直腸癌手術 ； 術後結果追蹤 ； 3年存活率

參考文獻

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