Survival outcomes following laparoscopic vs open surgery for non-metastatic rectal cancer:a two-center cohort study with propensity score matching  

腹腔镜对比开腹手术治疗非转移性直肠癌的远期生存:倾向评分匹配的双中心队列研究

作　　者：Kang-Lian Tan Hai-Jun Deng Zhi-Qiang Chen Ting-Yu Mou Hao Liu Run-Sheng Xie Xue-Min Liang Xiao-Hua Fan Guo-Xin Li 

机构地区：[1]Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong,P.R.China [2]Abdominal Pain Center,Guangdong Provincial Hospital of Chinese Medicine,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou,Guangdong,P.R.China

出　　处：《Gastroenterology Report》2020年第4期319-325,I0002,I0003,共9页胃肠病学报道（英文）

基　　金：supported by clinical research of Guangdong Provincial Hospital of Chinese Medicine[No.YN10101902];a scientific research project of Guangdong Provincial Academy of Chinese Medical Sciences[No.YN2018ML11].

摘　　要：Background:Laparoscopic surgery for rectal cancer is commonly performed in China.However,compared with open surgery,the effectiveness of laparoscopic surgery,especially the long-term survival,has not been sufficiently proved.Methods:Data of eligible patients with non-metastatic rectal cancer at Nanfang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese Medicine between 2012 and 2014 were retrospectively reviewed.Long-termsurvival outcomes and short-termsurgical safety were analysed with propensity score matching between groups.Results:Of 430 cases collated from two institutes,103 matched pairs were analysed after propensity score matching.The estimated blood loss during laparoscopic surgerywas significantly less than that during open surgery(P=0.019)and the operative time and hospital staywere shorter in the laparoscopic group(both P<0.001).The post-operative complications ratewas 9.7%in the laparoscopic group and 10.7%in the open group(P=0.818).No significant differencewas observed between the laparoscopic group and the open group in the 5-year overall survival rate(75.7%vs 80.6%,P=0.346),5-year relapse-free survival rate(74.8%vs 76.7%,P=0.527),or 5-year cancer-specific survival rate(79.6%vs 87.4%,P=0.219).An elevated carcinoembryonic antigen,<12 harvested lymph nodes,and perineural invasion were independent prognostic factors affecting overall survival and relapse-free survival.Conclusions:Our findings suggest that open surgery should still be the priority recommendation,but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer.背景:腹腔镜直肠癌手术在中国得到了广泛应用,但与开腹手术相比,腹腔镜手术的疗效尤其是远期生存仍未获充分证实。方法:回顾性分析2012-2014年间南方医科大学南方医院和广东省中医院的非转移性直肠癌病例的临床资料。采用倾向评分匹配方法比较腹腔镜组与开腹组患者的远期生存和近期安全性。结果:两个中心共纳入430例直肠癌患者,倾向评分匹配后获得103对病例。腹腔镜组较开腹组术中出血量减少(P=0.019),手术时间和住院时间缩短(均P<0.001)。两组术后并发症发生率分别为9.7%和10.7%(P=0.818)。两组5年总生存率(75.7%vs 80.6%,P=0.346)、5年无复发生存率(74.8%vs 76.7%,P=0.527)和5年肿瘤特异生存率(79.6%vs 87.4%,P=0.219)的差异均无统计学意义。癌胚抗原水平升高、淋巴结清扫数量不足12枚以及周围神经浸润均为总体生存和无复发生存的独立危险因素。结论:本研究结果提示,仍应将开腹手术作为非转移性直肠癌的治疗首选,但腹腔镜手术也是一项可以接受的治疗选择。

关 键 词：laparoscopic surgery open surgery propensity score matching rectal cancer 

分 类 号：R735.37[医药卫生—肿瘤]