关旭, 卢召, 王松, 刘恩瑞, 赵志勋, 陈海鹏, 张明光, 胡茜玥, 马晓龙, 黄海洋, 姜争, 刘正, 王贵玉, 王锡山. 3种经自然腔道取标本手术方式治疗直肠癌的安全性与肿瘤学预后对比研究[J]. 中国肿瘤临床, 2021, 48(3): 140-146. DOI: 10.3969/j.issn.1000-8179.2021.03.139
引用本文: 关旭, 卢召, 王松, 刘恩瑞, 赵志勋, 陈海鹏, 张明光, 胡茜玥, 马晓龙, 黄海洋, 姜争, 刘正, 王贵玉, 王锡山. 3种经自然腔道取标本手术方式治疗直肠癌的安全性与肿瘤学预后对比研究[J]. 中国肿瘤临床, 2021, 48(3): 140-146. DOI: 10.3969/j.issn.1000-8179.2021.03.139
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Xu Guan, Zhao Lu, Song Wang, Enrui Liu, Zhixun Zhao, Haipeng Chen, Mingguang Zhang, Xiyue Hu, Xiaolong Ma, Haiyang Huang, Zheng Jiang, Zheng Liu, Guiyu Wang, Xishan Wang. Comparison of clinical safety and oncological prognosis of three techniques in natural orifice specimen extraction surgery for rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(3): 140-146. DOI: 10.3969/j.issn.1000-8179.2021.03.139
Citation: Xu Guan, Zhao Lu, Song Wang, Enrui Liu, Zhixun Zhao, Haipeng Chen, Mingguang Zhang, Xiyue Hu, Xiaolong Ma, Haiyang Huang, Zheng Jiang, Zheng Liu, Guiyu Wang, Xishan Wang. Comparison of clinical safety and oncological prognosis of three techniques in natural orifice specimen extraction surgery for rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(3): 140-146. DOI: 10.3969/j.issn.1000-8179.2021.03.139
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3种经自然腔道取标本手术方式治疗直肠癌的安全性与肿瘤学预后对比研究

Comparison of clinical safety and oncological prognosis of three techniques in natural orifice specimen extraction surgery for rectal cancer

    摘要
  • 摘要:
      目的  探讨经自然腔道取标本手术(natural orifice specimen extraction surgery，NOSES)的安全性，并比较3种取标术式在直肠癌治疗中的近期疗效和远期预后。
      方法  回顾性分析接受腹腔镜NOSES的Ⅰ~Ⅲ期直肠癌患者的临床资料。直肠NOSES手术包括外翻切除式、拉出切除式和切除拖出式3种。比较3种取标本方式的术后并发症、5年无病生存期(disease-free survival，DFS)、5年局部复发率(local recurrence rate，LRR)和5年远处转移率(distant metastasis rate，DMR)等指标。
      结果  本研究共有268例直肠癌患者符合入组标准，包括83例外翻切除式，75例拉出切除式，110例切除拖出式。肿瘤位置与手术方式的选择具有显著相关性，术后全部患者的并发症发生率为12.3%，其中外翻切除组为18.1%，高于拉出切除组(13.3%)和切除拖出组(7.3%)，P=0.073。全部患者5年DFS、LRR及DMR分别是85.0%、4.2%和11.0%。切除拖出组患者5年DFS高于其他两组，外翻切除组患者5年LRR要高于其他两组，而5年DMR在外翻切除组中最低，差异均无统计学意义。
      结论  直肠癌NOSES 3种术式具有良好安全性和肿瘤学预后，肿瘤位置是选择手术方式的决定因素。

     

    Abstract:
      Objective  To evaluate the safety of natural orifice specimen extraction surgery (NOSES) and to compare the short- and longterm outcomes of three techniques of NOSES for rectal cancer (RC).
      Methods  A consecutive series of patients with stage Ⅰ-ⅢRC who underwent laparoscopic NOSES were enrolled. The three main techniques of NOSES included specimen eversion and extra-abdominal resection (EVER), specimen extraction and extra-abdominal resection (EXER), and intra-abdominal resection and specimen extraction (IREX). The postoperative complication rate, 5-year disease-free survival (DFS) rate, 5-year local recurrence rate (LRR), and 5-year distant metastasis rate (DMR) were compared among the three techniques.
      Results  A total of 268 RC patients met the inclusion criteria, including 83 patients treated with EVER, 75 patients treated with EXER, and 110 patients treated with IREX. Tumor location was the most critical factor associated with technique selection. The postoperative complication rate was 12.3% in all patients, 18.1% for EVER, 13.3% for EXER, and 7.3% for IREX (P=0.073). Regarding long-term outcomes, the 5-year DFS, 5-year LRR, and 5-year DMR were 85.03%, 4.22%, and 11.00%, respectively, in all patients. The 5-year DFS rate was higher in the IREX group than in the other two groups; the 5-year LRR was higher in the EVER group than in the other two groups; and the 5-year DMR was the lowest in the EVER group, but the difference was not statistically significant.
      Conclusions  The three techniques of NOSES for RC showed acceptable safety and oncological outcomes. Tumor location was a determinant of technique selection.

     

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