腹腔镜与开腹直肠癌根治术肿瘤切除完整性及长期疗效的比较

目的：比较腹腔镜与开腹直肠癌根治术的肿瘤切除完整性及长期预后。方法回顾性分析2005年7月至2011年12月在上海第二军医大学长海医院肛肠外科行直肠癌根治手术的1184例患者的临床及随访资料，根据其手术方式分为腹腔镜手术组（腹腔镜组，104例）和开腹手术组（开腹组，1080例），对两组患者的一般情况、术中清扫淋巴结数目、远切缘距离、吻合口相关并发症发生率、术后无病生存率及总生存率进行比较。结果腹腔镜组与开腹组患者的临床资料具有可比性，两组平均清扫淋巴结数目（15．5枚/例比14．4枚/例）、远切缘平均距离（2．5 cm比2．1 cm）及吻合口相关并发症发生率1．9％（2/104）比1．9％（20/1080）]差异均无统计学意义（P＞0．05）；腹腔镜组术后3年和5年无病生存率分别为79．0％和69．3％，开腹组分别为78．0％和72．5％，差异无统计学意义（P＞0．05）；腹腔镜组术后3年和5年总体生存率分别为93．5％和81．2％，开腹组分别为87．6％和80．7％，差异亦无统计学意义（P＞0．05）。结论直肠癌腹腔镜手术肿瘤切除完整性和远期疗效与开腹手术相当。

Comparison of oncologic clearance and long-term outcomes of laparoscopic surgery versus open ;surgery in radical resection of rectal cancer

Objective To compare the oncologic clearance and long-term outcomes between laparoscopic surgery and open surgery in radical resection of rectal cancer. Methods Clinicopathological and follow-up data of 1184 cases with rectal cancer undergoing radical resection from July 2005 to December 2011 were analyzed retrospectively. According to the surgical method , cases were divided into laparoscopy group （104 cases） and open group （1080 cases）. Demographics, number of harvested lymph nodes, distance between distal margin and tumor, incidence of anastomotic complications, disease-free survival （DFS） and overall survival （OS） were compared between the two groups. Results There were no significant differences in the number of harvested lymph nodes（15.5 vs. 14.4, P〉0.05）, length of distal margin （2.5 cm vs. 2.1 cm, P〉0.05） and incidence of anastomotic complications （1.9% vs. 1.9%, P〉0.05） between the two groups. And there were no significant differences in DFS and OS between the two groups （both P〉0.05）. The 3-year and 5-year DFS in laparoscopy group were 79.0% and 69.3%, and were 78.0% and 72.5% in open group. The 3-year and 5-year OS in laparoscopy group were 93.5% and 81.2%, which were 87.6% and 80.7% in open group. There were no significant differences in DFS and OS after stratification by TNM stage. Conclusion The oncologic clearence and long-term outcomes after laparoscopic surgery are comparable with open surgery in radical resection of rectal cancer.