進行大腸癌に対する腹腔鏡下手術の低侵襲性および患者QOL

Minimal invasiveness and patients'quality of life after laparoscopic surgery for advanced colorectal cancer

◆要旨：大腸癌に対する腹腔鏡下手術の低侵襲性と患者quality of life（QOL）について述べる．低侵襲性を客観的に表す指標としてサイトカインを用いた．教室で，進行大腸癌を対象に腹腔鏡下手術と開腹手術とを比較するRCTを行い，血清interleukin-6，NK細胞活性，CRP，白血球数を測定した．結果は1 POD，4 PODにおける腹腔鏡下群のCRP値が，開腹群に比べて有意に低かった以外は，差を認めなかった．欧米で行われたRCT（COST，CLASICC，COLOR）では，患者QOLを測定した．術後早期における患者QOLは，開腹群と比べると腹腔鏡群で良好であるとする報告もあるが，術後3か月では開腹群と差を認めなかった．

　We describe the minimal invasiveness and patients'quality of life after laparoscopic surgery for colorectal cancer. We conducted a randomised controlled trial comparing laparoscopic with open surgery for advanced colorectal cancer, and measured the serum level of interleukin-6, natural killer cell activity together with the serum level of C-reactive protein. There were no differences between the laparoscopic and open groups in terms of interleukin-6 level and natural killer cell activity. However, the serum levels of C-reactive protein on postoperative day 1 and 4 were significantly lower in the laparoscopic than in the open group.

　Large randomised controlled trials（COST, CLASICC, COLOR）included the evaluation of the quality of life after surgery. In one of the studies, a better quality of life after laparoscopic surgery was reported at early phase but the difference was of little clinical value, and no difference was found at 3 months postoperatively.