同時性多発大腸癌に対する腹腔鏡下大腸切除術の検討

Laparoscopic surgery for multiple colorectal cancers

◆要旨：［目的］同時性多発大腸癌に対して吻合部が2か所となった腹腔鏡下大腸切除術の工夫と短期成績を明らかにすること．［対象］同時性多発大腸癌を認め腹腔鏡下にそれぞれ切除し吻合部が2か所となった11例．［結果］全例，5ポートで行い，小開腹は臍部で施行し，一時的人工肛門は造設しなかった．開腹移行・術中合併症は認めず，手術時間中央値271分（223〜325分）であった．Clavien-Dindo classification Grade IIの術後合併症を4例（腸閉塞2例，腸炎1例，尿路感染1例）認めた．［結論］吻合部が2か所となる腹腔鏡下大腸切除術は，安全に施行でき，重篤な術後合併症を認めなかった．

［Purpose］The aim of this study was to evaluate short-term outcomes of laparoscopic surgery with two segmental colorectal resections and anastomoses for multiple synchronous colorectal cancers. ［Patients and Method］ Eleven patients with multiple colorectal cancers underwent two synchronous segmental colorectal resections and anastomoses without diverting stoma construction. Methods of procedures, operative results, and postoperative outcomes were evaluated. ［Results］ Median operative time was 271 min（range, 223-325 min） and median blood loss was 26 ml（range, 0-105 ml）. No conversions to open surgery or intraoperative complications were encountered. Postoperative complications occurred in 4 patients with Clavien-Dindo classification Grade II（two ileus, one enteritis, and one urinary infection）. ［Conclusion］ Laparoscopic surgery with two segmental colorectal resections and anastomoses was a safe procedure without severe postoperative complications. This option seems to offer a feasible option for multiple synchronous colorectal cancers.