Accuracy of laparoscopic colorectal resection for cancer: A prospective multicenter study
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文摘
Laparoscopic colorectal surgery for cancer is presently under discussion. A prospective observational multicentre study was initiated on Aug. 1, 1995, in the German-speaking countries of Europe. We present the results after one year with respect to the accuracy and quality of oncological resections. Out of 500 operations, 231 (46 % ) were performed for cancer, 167 (33 % ) with curative intent. The mean age of the patients was 66 years (Cl 5-95 % : 64-68) and the male-to-female ratio was 1.0. The most common curative resections were: 63 anterior rectum resections (38 % ), 51 sigmoid resections (30 % ), and 27 amputations of the rectum (16 % ). Segmental resections were performed in 20 patients (11 % ) in selected indications. Intraoperative tumour spillage was reported in 2 % . Resection margins were tumour-free in every case. The mean number of lymph nodes harvested was 13.0 (Cl 5-95 % : 11.5 to 14.6), with significant differences between participating (Kruskal-Wallis, DF = 12, p < 0.0001). In the case of anterior resections, the mean distal resection margin was 39 mm (Cl 5-95 % : 33 to 45). Comparison of these results with recent data obtained by the German Study Group Colo-Rectal Carcinoma (SGCRC) for conventional colorectal surgery revealed no relevant differences between laparoscopic and open colorectal surgery in terms of the oncological quality criteria. The surgeon appears to be a risk factor in both surgical modalities. Since the incidence of port-site metastases and long-term survival after curative laparoscopic surgery for colorectal cancer are still unknown, we continue to recommend that such operations should not be performed outside the confines of a prospective study.