Perioperative Outcomes Between Laparoscopic and Conventional Open Lateral Pelvic Lymph Node Dissection following Total Mesorectal Excision for Mid-low Rectal Cancer
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摘要:目的
比较中低位直肠癌患者在腹腔镜与开放全直肠系膜切除术（TME）基础上行侧方淋巴结清扫的围手术期临床结果，以探讨腹腔镜盆腔淋巴结清扫术的可行性及安全性。
方法对浙江省肿瘤医院同期16例腹腔镜及55例开放侧方淋巴结清扫术患者临床资料进行回顾性分析，比较了两组间围手术期手术时间、术中出血量、侧方淋巴结清扫数目、术后并发症及术后住院时间。
结果腹腔镜组与开放组患者基础临床特征相似。两组患者均无围手术期死亡。腹腔镜组患者无中转开腹手术。腹腔镜组比开放组手术时间显著延长（218.6±71.6 min vs. 181.3±57.9 min, P=0.035）、术中出血量显著减少（190.6±80.1 ml vs. 344.9±295.2 ml, P=0.044）。腹腔镜组与开放组清扫的侧方淋巴结数目（9.8±6.1枚vs. 11.0±9.7枚, P=0.642）、侧方淋巴结转移阳性率（25.0% vs. 34.5%, P=0.556）、术后并发症发生率（25.0% vs. 20.0%, P=0.666）、术后住院时间（10.9±3.5天vs. 13.8±7.1天, P=0.125）差异均无统计学意义。侧方淋巴结转移与肿瘤低分化（P=0.001）、阳性脉管瘤栓（P=0.011）和神经侵犯（P=0.002）相关，但与术前是否行放化疗（P=0.479）及肿瘤大小（P=0.907）无关。
结论腹腔镜直肠癌全系膜切除术基础上的侧方淋巴结清扫是安全可行的，并能达到和传统开放手术同样的围手术期临床效果。
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关键词:
- 直肠癌 /
- 腹腔镜 /
- 侧方淋巴结清扫 /
- 直肠全系膜切除术(TME)
Abstract:ObjectiveBy comparing its perioperative outcomes with that of conventional open surgery, this study was to determine the feasibility and safety of laparoscopic lateral pelvic lymph node dissection following total mesorectal excision (TME) for mid-low rectal cancer.
MethodsWe retrospectively analyzed clinical records of 16 patients underwent laparoscopic surgery and 55 patients treated with open surgery at Zhejiang Cancer Hospital during the same period. Perioperative outcomes such as operative time, intraoperative blood loss, number of lateral lymph node harvested, postoperative complications and length of hospital stay after surgery were compared between the two groups.
ResultsLaparoscopic and open surgery groups had similar baseline clinical features. No laparoscopic patients were converted to open surgery. No patients died during the perioperative period. Compared with the open surgery group, the laparoscopic group had significantly longer operative time(218.6±71.6 min vs. 181.3±57.9 min, P=0.035), but less intraoperative blood loss(190.6±80.1 ml vs. 344.9±295.2 ml, P=0.044). There was no significant difference between laparoscopic and open surgery groups in the length of hospital stay after surgery(10.9±3.5 days vs. 13.8±7.1 days, P=0.125), the rates of postoperative complications (25.0% vs. 20.0%, P=0.666), the mean numbers of harvested lateral lymph nodes(9.8±6.1 vs. 11.0±9.7, P=0.642) and lateral lymph node metastasis rates(25.0% vs. 34.5%, P=0.556). Lateral lymph node metastasis was significantly associated with tumor differentiation(P=0.001), intravascular tumor emboli(P=0.011) and neural infiltration(P=0.002), but not with preoperative chemoradiotherapy(P=0.479) or tumor size(P=0.907).
ConclusionLaparoscopic lateral lymph node dissection following TME for mid-low rectal cancer is feasible and safe. It could achieve the same perioperative clinical outcomes as conventional open surgery.
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Key words:
- Rectal cancer /
- Laparoscopy /
- Lateral pelvic lymph node dissection /
- TME
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表 1 腹腔镜组与开放组患者临床病理特征比较
Table 1 Comparison of clinicopathological features between laparoscopic and open surgery groups
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表 2 临床病理因素与侧方淋巴结转移的关系
Table 2 Correlation between clinicopathological factors and pelvic lateral lymph node metastasis
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