Comparison on the short- and long-term clinical efficacy between laparoscopic and open radical resection of cectal rancer in a single centre

doi:10.3877/cma.j.issn.1674-0793.2017.05.002

Abstract

Abstract:

Objective

To discuss the surgical feasibility, oncological safety, advantages and disadvantages of laparoscopic radical resection of rectal cancer (RC) by comparing the short- and long-term clinical efficacy between laparoscopic and open surgery.

Methods

From January 2008 to December 2014, nine hundred and forty-nine RC cases were divided into laparoscopic group (undergoing laparoscopic radical resection) and open group (undergoing open radical resection). The basic clinical data, surgical parameters, oncological pathology indicators and the postoperation follow-up data were analyzed retrospectively.

Results

(1) There was no statistical difference on the basic clinical data between the laparoscopic group (394 cases) and the open group (555 cases). (2) Compared with the open group, the laparoscopic group had less surgical blood loss, preventive colostomy rate, time of fart recovery, defecation recovery and pulling out the abdominal cavity drainage tube, and took shorter time in hospital both of postoperation and the total (P<0.05). However, the laparoscopic group took more surgical time and hospitalized costs. Except for the lower incidence of surgical massive bleeding, the laparoscopic group were statistically similar to the incidence of other complications. (3) There was no statistical difference in oncology pathology indicators, tumor recurrence, disease free survival rate and overall survival rate between the two groups. (4) In the subgroup analysis by pTNM stages, the long-term survival between the two groups also had no significant difference.

Conclusion

The laparoscopic radical resection of rectal cancer is feasible and safe, with similar clinical efficacy as the open surgery.

Key words: Rectal neoplasms, Laparoscopes, Laparotomy, Treatment outcome

Yueming Huang, Xinhua Zhang, Jianhui Chen, Chuangqi Chen. Comparison on the short- and long-term clinical efficacy between laparoscopic and open radical resection of cectal rancer in a single centre[J]. Chinese Archives of General Surgery(Electronic Edition), 2017, 11(05): 298-304.

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References 20

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临床资料		腹腔镜组(394例)	开腹组(555例)	统计值	P值
性别(例)				χ²=1.215	0.270
	男	236	352
	女	158	203
年龄(岁，例)		58.64±11.94	59.17±13.04	t=0.642	0.521
	≤60	220	281	χ²=2.507	0.113
	>60	174	274
术前合并基础疾病(例)				χ²=0.394	0.544
	无	309	426
	有	85	129
BMI (kg/m²)		22.61±3.35	22.37±3.02	t=1.158	0.247
术前血CEA水平(μg/L,例)				χ²=1.241	0.265
	<5	272	364
	≥5	122	191
肿瘤所在部位(例)				χ²=0.060	0.807
	腹膜反折以上	202	289
	腹膜反折以下	192	266
肿瘤下缘离肛缘距离(cm)		6.96±3.84	6.64±3.50	t=1.307	0.191
住院总天数(d)		20.94±12.40	22.75±9.71	t=2.519	0.012
住院总费用(万元)		6.36±1.74	5.19±1.42	t=11.394	<0.001
术前cTNM分期(例)				χ²=5.607	0.061
	Ⅰ	63	89
	Ⅱ	136	231
	Ⅲ	195	235
术后辅助化疗率[例(%)]		237/281(83.34)	358/421(85.04)	χ²=0.063	0.802^a

临床资料		腹腔镜组(394例)	开腹组(555例)	统计值	P值
性别(例)				χ²=1.215	0.270
	男	236	352
	女	158	203
年龄(岁，例)		58.64±11.94	59.17±13.04	t=0.642	0.521
	≤60	220	281	χ²=2.507	0.113
	>60	174	274
术前合并基础疾病(例)				χ²=0.394	0.544
	无	309	426
	有	85	129
BMI (kg/m²)		22.61±3.35	22.37±3.02	t=1.158	0.247
术前血CEA水平(μg/L,例)				χ²=1.241	0.265
	<5	272	364
	≥5	122	191
肿瘤所在部位(例)				χ²=0.060	0.807
	腹膜反折以上	202	289
	腹膜反折以下	192	266
肿瘤下缘离肛缘距离(cm)		6.96±3.84	6.64±3.50	t=1.307	0.191
住院总天数(d)		20.94±12.40	22.75±9.71	t=2.519	0.012
住院总费用(万元)		6.36±1.74	5.19±1.42	t=11.394	<0.001
术前cTNM分期(例)				χ²=5.607	0.061
	Ⅰ	63	89
	Ⅱ	136	231
	Ⅲ	195	235
术后辅助化疗率[例(%)]		237/281(83.34)	358/421(85.04)	χ²=0.063	0.802^a

组别	手术方式(例)		手术时间(min, ±s)	术中出血量(ml, ±s)	预防性肠造口率[例(%)]
组别	Dixon术	Miles术	手术时间(min, ±s)	术中出血量(ml, ±s)	预防性肠造口率[例(%)]
腹腔镜组(394例)	351	43	240.89±91.15	102.99±128.59	8/351(2.28)
开腹组(555例)	488	67	208.48±55.89	201.95±222.46	28/488(5.74)
统计值	0.302^a		6.774	7.937	5.946 ^a
P值	0.583		<0.001	<0.001	0.015 ^b
组别	术后恢复排气时间(d,±s)	恢复排便时间(d,±s)	术后拔除引流管时间(d, ±s)	术后住院天数(d, ±s)
腹腔镜组(394例)	3.10±1.51	4.05±2.35	6.07±4.02	11.24±11.31
开腹组(555例)	3.95±1.65	5.38±2.33	7.42±4.94	12.63±8.41
统计值	8.053	8.639	4.484	2.185
P值	<0.001	<0.001	<0.001	0.029

组别	手术方式(例)		手术时间(min, ±s)	术中出血量(ml, ±s)	预防性肠造口率[例(%)]
组别	Dixon术	Miles术	手术时间(min, ±s)	术中出血量(ml, ±s)	预防性肠造口率[例(%)]
腹腔镜组(394例)	351	43	240.89±91.15	102.99±128.59	8/351(2.28)
开腹组(555例)	488	67	208.48±55.89	201.95±222.46	28/488(5.74)
统计值	0.302^a		6.774	7.937	5.946 ^a
P值	0.583		<0.001	<0.001	0.015 ^b
组别	术后恢复排气时间(d,±s)	恢复排便时间(d,±s)	术后拔除引流管时间(d, ±s)	术后住院天数(d, ±s)
腹腔镜组(394例)	3.10±1.51	4.05±2.35	6.07±4.02	11.24±11.31
开腹组(555例)	3.95±1.65	5.38±2.33	7.42±4.94	12.63±8.41
统计值	8.053	8.639	4.484	2.185
P值	<0.001	<0.001	<0.001	0.029

组别	例数	并发症总发生率	术中大出血(≥1 000 ml)	输尿管损伤	肺部感染	腹腔内感染	泌尿系感染
腹腔镜组	394	73 (18.53)	1(0.25)	1(0.25)	6(1.52)	15(3.81)	9(2.28)
开腹组	555	85 (15.32)	12(2.16)	4(0.72)	10(1.80)	10(1.80)	5(0.90)
χ²值		1.714	6.211	0.275	0.108	3.612	3.034
P值		0.191	0.011	0.600 ^a	0.804	0.065	0.102
组别	尿潴留	腹腔内出血	深静脉血栓形成	肠梗阻	切口感染	吻合口出血^c	吻合口瘘^c
腹腔镜组	10 (2.54)	3(0.76)	0(0)	8(2.03)	14(3.55)	8(2.28)	29(8.26)
开腹组	12 (2.16)	5(0.90)	2(0.36)	13(2.34)	15(2.70)	7(1.43)	27(5.53)
χ²值	0.144	0.000	-	0.144	0.563	0.830	2.441
P值	0.827	1.000 ^a	0.514 ^b	0.748	0.452	0.362	0.118

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