治癒切除不能StageⅣ大腸癌に対する腹腔鏡下手術と開腹手術の比較検討

Experience of laparoscopy-assisted colorectal resection for stageⅣcolorectal cancer : in comparison with open resection

◆要旨：【目的】治癒切除不能StageⅣ大腸癌の原発巣切除に対する腹腔鏡下手術の安全性，妥当性を検討した．【対象・方法】StageⅣ大腸癌の原発巣切除のうち，1995年4月～2007年8月の腹腔鏡補助下大腸切除術（以下，LAC）14例と，2006年3月から2007年12月の開腹大腸切除術（以下，OC）21例をretrospectiveに比較した．【結果】LAC群で有意に年齢が高かったが，性別，BMI，手術時間および術後合併症に差を認めなかった．術中出血量，術後の離床および化学療法開始までの日数はLAC群で有意に良好であった．1・2年生存率は両群間に差を認めなかった（p＝0.26）．【結論】治癒切除不能StageⅣ大腸癌の原発巣切除に対するLACは，OCと比較して術後経過が良好で早期に化学療法を開始できることより，よい適応と考えられた．

　Purpose : This study aimed to review the outcomes of laparoscopy-assisted colorectal resection for patients with stageⅣcolorectal cancer. Subjects: From the retrospectively collected database for patients who underwent surgery for colorectal cancer in our institution, those with stageⅣcolorectal cancer who underwent elective resection of tumor during the period from April 1995 to August 2006 were included. The outcomes of those with laparoscopy-assisted resection（LAC）were reviewed and comparison was made between patients with LAC and open resection（OC）. Results : Median age was higher in LAC, but there was no difference in gender, body mass index（BMI）, surgical time, postoperative complication rate, and the median postoperative hospital stay. Intraoperative blood loss was significantly lower for LAC（70 g versus 275 g, p<0.01）, and the median duration until the start of postoperative chemotherapy was significantly shorter in LAC（21 days versus 43 days, p<0.01）. No significant difference in the overall 1-year and 2-year survival rates was observed between the groups（p=0.26）. There was no operative mortality in both groups. Conclusions : Laparoscopy-assisted colorectal resection can be performed safely in patients with stageⅣcolorectal cancer, and postoperative course and the duration to start chemotherapy compared favorably with patients with open colorectal resection.