内容紹介
Summary
To evaluate the less invasiveness of laparoscopic surgery for colorectal cancer, we compared open and laparoscopic surgery for sigmoid or recto-sigmoid cancer operations undergoing the same procedures. One hundred forty-three patients curatively resected with D3 dissection were enrolled. All cases underwent the following procedure; high ligation of the inferior mesenteric artery(IMA)with median approach and double stapling technique(DST)for anastomosis. The clinicopathological factors were examined in 70 cases of open surgery(OC)and 73 cases of laparoscopic surgery(LAC). The mean age of all cases was 66(38-88)years, including 83 men and 60 women. The mean operation time was 189(82-413)minutes and the mean blood loss was 45(5-1,025)mL. Postoperative complications were reported in 45 cases including 10 cases with surgical site infection(SSI)and 10 cases with remote infection(RI). There was no difference in sex, BMI, PS, and ASA between the 2 groups; however, the patients were significantly older and the tumor maximum diameter significantly larger in the OC group. There was no significant difference in operation time but the blood loss was significantly lower in the LAC group. There were no differences in postoperative complications, first gait, WBC, and body temperature on postoperative day(POD)3, but the first flatus was earlier and the CRP level was significantly lower on POD 3 in the LAC group. There was no difference in the CRP level on POD 3 in the age, tumor diameter, and blood loss which showed a difference in the both group. Laparoscopic surgery was considered less invasive than open surgery because the serum CRP level was lower in the LAC group.
要旨
腹腔鏡手術の低侵襲性を評価する目的で,手順が同じS状結腸・直腸S状部癌手術を対象に開腹手術と腹腔鏡手術を比較検討した。D3郭清を施行した治癒切除S状結腸・直腸S状部癌症例143例を対象とした。手術手順は全例,内側アプローチでIMA根部結紮,吻合はdouble stapling technique(DST)で施行した。開腹手術(OC)70例,腹腔鏡手術(LAC)73例につき,臨床病理学的因子を検討した。全症例の年齢は66(38～88)歳,男性83例,女性60例。手術時間は189(82～413)分,出血量は45(5～1,025)mLであった。術後合併症を45例に認め,うち手術部位感染10例,遠隔感染を10例に認めた。両群の比較では,性別,BMI,PS,ASAに差はなかったが,OC群は高齢で腫瘍最大径が大きかった。手術時間には差がないが,出血量はLAC群で少なかった。術後合併症,歩行開始日,第3病日の体温,WBC数には差はないが,初回排ガス日はLAC群で早く,第3病日のCRP値もLAC群で有意に低値であった。両群の背景で差を認めた年齢,腫瘍径,出血量では第3病日のCRP値に差は認めなかった。腹腔鏡手術で血清CRP値が低値であったことより,腹腔鏡手術がより低侵襲と考えられた。
目次
To evaluate the less invasiveness of laparoscopic surgery for colorectal cancer, we compared open and laparoscopic surgery for sigmoid or recto-sigmoid cancer operations undergoing the same procedures. One hundred forty-three patients curatively resected with D3 dissection were enrolled. All cases underwent the following procedure; high ligation of the inferior mesenteric artery(IMA)with median approach and double stapling technique(DST)for anastomosis. The clinicopathological factors were examined in 70 cases of open surgery(OC)and 73 cases of laparoscopic surgery(LAC). The mean age of all cases was 66(38-88)years, including 83 men and 60 women. The mean operation time was 189(82-413)minutes and the mean blood loss was 45(5-1,025)mL. Postoperative complications were reported in 45 cases including 10 cases with surgical site infection(SSI)and 10 cases with remote infection(RI). There was no difference in sex, BMI, PS, and ASA between the 2 groups; however, the patients were significantly older and the tumor maximum diameter significantly larger in the OC group. There was no significant difference in operation time but the blood loss was significantly lower in the LAC group. There were no differences in postoperative complications, first gait, WBC, and body temperature on postoperative day(POD)3, but the first flatus was earlier and the CRP level was significantly lower on POD 3 in the LAC group. There was no difference in the CRP level on POD 3 in the age, tumor diameter, and blood loss which showed a difference in the both group. Laparoscopic surgery was considered less invasive than open surgery because the serum CRP level was lower in the LAC group.
要旨
腹腔鏡手術の低侵襲性を評価する目的で,手順が同じS状結腸・直腸S状部癌手術を対象に開腹手術と腹腔鏡手術を比較検討した。D3郭清を施行した治癒切除S状結腸・直腸S状部癌症例143例を対象とした。手術手順は全例,内側アプローチでIMA根部結紮,吻合はdouble stapling technique(DST)で施行した。開腹手術(OC)70例,腹腔鏡手術(LAC)73例につき,臨床病理学的因子を検討した。全症例の年齢は66(38～88)歳,男性83例,女性60例。手術時間は189(82～413)分,出血量は45(5～1,025)mLであった。術後合併症を45例に認め,うち手術部位感染10例,遠隔感染を10例に認めた。両群の比較では,性別,BMI,PS,ASAに差はなかったが,OC群は高齢で腫瘍最大径が大きかった。手術時間には差がないが,出血量はLAC群で少なかった。術後合併症,歩行開始日,第3病日の体温,WBC数には差はないが,初回排ガス日はLAC群で早く,第3病日のCRP値もLAC群で有意に低値であった。両群の背景で差を認めた年齢,腫瘍径,出血量では第3病日のCRP値に差は認めなかった。腹腔鏡手術で血清CRP値が低値であったことより,腹腔鏡手術がより低侵襲と考えられた。