肥胖对腹腔镜直肠癌手术结果的影响

目的探讨肥胖对直肠癌腹腔镜手术可行性、安全性和远期生存结果的影响。方法回顾性分析2007年10月-2009年12月间收治的147例腹腔镜直肠癌手术治疗患者的临床资料。根据international obesity task Force(IOTF)的标准将患者分为三组：非肥胖组(body mass index,BMI＜25.0 kg/m2)101例、超重组(BMI 25.0~29.9 kg/m2)37例和肥胖组(BMI≥30.0 kg/m2)9例。对三组患者的人口学特征、临床资料、手术结果和长期生存进行对比分析。结果三组间性别、年龄、ASA分级、手术方式、肿瘤大小和肿瘤下缘距肛缘距离无差异,超重组和肥胖组患者的合并症多于非肥胖组(P=0.036)。非肥胖组、超重组和肥胖组的手术时间、术后并发症、术后排气时间、术后住院时间无差异、淋巴结清扫数目和腹腔镜直肠癌前切除或低位前切除术的下切缘距离三组间无差异。中转开腹率非肥胖组、超重组和肥胖组分别为4.0%、13.5%和0(P=0.112)。非肥胖组、超重组和肥胖组的3年无瘤生存率分别为78.5%、55.7%和100%,差异无统计学意义(Log rank值=0.993,P=0.319)。结论超重和肥胖患者直肠癌腹腔镜手术安全可行,不影响远期生存结果。

Impact of Obesity on Laparoscopic Surgery for Rectal Cancer

ObjectiveTo assess the feasibility,safety,and long term outcomes of laparoscopic surgery in obese patientswith rectal cancer.MethodsWe retrospectively reviewed the data of 147 consecutive patients whounderwent laparoscopic surgery for rectal cancer from October 2007 to December 2009.Patients wereclassified according to the categories proposed by the International Obesity Task Force,as Nonobese(body mass index［BMI］＜25.0 kg/m2),overweight (BMI 25.0~29.9 kg/m2),and obese (BMI≥30.0 kg/m2)groups.Surgical,oncologic,and long term results were compared among the patients in thenonobese,overweight and obese groups.ResultsOf the 147 patients,101,37,and 9 were classified asnonobese,overweight and obese groups,respectively.Clinicopathologic characteristics were similaramong the three groups;while the comorbidity of patients in the overweight and obese groups were morethan that in the nonobese groups(P=0.036).There were no differences among the groups in terms ofcomplication rates,operative time,blood loss,distal margin for anterior resection or low anteriorresection,and the number of the lymph node harvested(P>0.05).There was no significant differences in the conversion rate among the three groups(P=0.112),which was4.0%,13.5% and 0 in the nonobese,obese and overweight groups,respectivtly.The median follow up was 24months.The overall 3-year disease free survival was 74.2%,and the 3-year disease free survival of thepatients in the nonobese,overweight and obese patients were 78.5%,55.7% and 100%,respectively (Logrank stastics=0.993,P=0.319).ConclusionLaparoscopic surgery of rectal cancer in overweight and obesepatients is feasible and safe,and not affect the long term survival.