Abstract:Objective: To evaluate the advantages of laparoscopic and open abdominoperineal resection(APR) by comparing clinicopathological results of the two methods. Methods: We collected clinical data from consecutive patients who underwent APR for rectal cancer from January in 2012 to January in 2016, compared the surgical outcomes and longtime survival of a laparoscopic surgery group (LG) with those of an open surgery group (OG). Results: A total of 158 patients were analyzed, with 84 in LG and 74 in OG. A total of 139 patients were kept. Then each group had 49 cases by using propensity matching analysis (1 ∶1). The perioperative clinical and pathological factors between two groups had no significant difference. Compared with OG, LG had less intraoperative bleeding and decline of hemoglobin, albumin and globin affected by surgery, lower rate of postoperative infection of abdominal and surgical site, lighter severity degree of postoperative complications, shorter resumed oral intake time and postoperative hospitalization lengths and higher hospital charges (all P<0.05). However, there was no significant difference in prognosis between two groups (P=0.754, 95%CI: 0.467-2.864). Conclusion: The laparoscopic surgery has better shortterm and similar longterm outcomes in treating patients with rectal cancer.
徐逸昕, 奚诚, 叶年源, 王一波. 腹腔镜与开腹经腹会阴直肠切除术治疗低位直肠癌的疗效对比:基于倾向性匹配分析[J]. 江苏大学学报:医学版, 2019, 29(04): 351-355.
XU Yi-xin, XI Cheng, YE Nian-yuan, WANG Yi-bo. Laparoscopic versus open abdominoperineal rectal resection for the treatment of low rectal cancer: based on propensity matching analysis. Journal of Jiangsu University(Medicine Edition), 2019, 29(04): 351-355.
[1]Kusters M, Marijnen CA, van de Velde CJ, et al. Patterns of local recurrence in rectal cancer; a study of the Dutch TME trial\[J\]. Eur J Surg Oncol, 2010, 36(5): 470-476.[2]Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy)\[J\]. Surg Laparosc Endosc, 1991, 1(3): 144-150.[3]Theophilus M, Platell C, Spilsbury K. Longterm survival following laparoscopic and open colectomy for colon cancer: a metaanalysis of randomized controlled trials\[J\]. Colorectal Dis, 2014, 16(3): 75-81.[4]Binefa G, RodriguezMoranta F, Teule A, et al. Colorectal cancer: from prevention to personalized medicine\[J\]. World J Gastroenterol, 2014, 20(22): 6786-6808.[5]Wittekind C. 2010 TNM system: on the 7th edition of TNM classification of malignant tumors\[J\]. Pathologe, 2010, 31(5): 331-332.[6]Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey\[J\]. Ann Surg, 2004, 240(2): 205-213.[7]Honda M, Yamamoto K, Furukawa TA. Retrospective propensity score matching and the selection of surgical procedures: how precise can a propensity estimate be?\[J\]. J Clin Oncol, 2014, 32(28): 3200-3201.[8]Moghadamyeghaneh Z, Phelan M, Smith BR, et al. Outcomes of open, laparoscopic, and robotic abdominoperineal resections in patients with rectal cancer\[J\]. Dis Colon Rectum, 2015, 58(12): 1123-1129.[9]Ying HQ, Deng QW, He BS, et al. The prognostic value of preoperative NLR, dNLR, PLR and LMR for predicting clinical outcome in surgical colorectal cancer patients\[J\]. Med Oncol, 2014, 31(12): 305.[10]Jung SB, Lee HI, Oh HK, et al. Clinicopathologic parameters for prediction of microsatellite instability in colorectal cancer\[J\]. Cancer Res Treat, 2012, 44(3): 179-186.[11]Vennix S, Pelzers L, Bouvy N, et al. Laparoscopic versus open total mesorectal excision for rectal cancer\[J\]. Cochrane Database Syst Rev, 2013,84(12): 1076.[12]Aramaki O, Takayama T, Higaki T, et al. Decreased blood loss reduces postoperative complications in resection for hepatocellular carcinoma\[J\]. J Hepatobiliary Pancreatic Sci, 2014, 21(8): 585-591.[13]Zhou D, Ye M, Bai Y, et al. Prognostic value of lymph node ratio in survival of patients with locally advanced rectal cancer\[J\]. Can J Surg, 2015, 58(4): 237-244.[14]Gehrman J, Bjorholt I, Angenete E, et al. Health economic analysis of costs of laparoscopic and open surgery for rectal cancer within a randomized trial (COLOR Ⅱ)\[J\]. Surg Endosc, 2017, 31(3): 1225-1234.