如何在大腸癌腹腔鏡右半結腸切除手術 建立一個完美的腸吻合？ 以病人安全為出發點

中文摘要研究目的：在結腸癌的患者中，右半結腸切除手術是一個標準治療手術，在進入了微創手術的時代，腹腔鏡右半結腸切除手術（LRHC）的比例則是越來越高。在腫瘤切除後，腸吻合方式包括體內吻合（ICA）或體外吻合（ECA）。然而，ICA與ECA對患者預後的影響仍存在著爭議。因此，本研究旨在評估並比較使用ICA與ECA的LRHC在短期及長期之結果。研究方法及資料：本研究為一回顧性研究，收案年限為從2017至2020年，病人的納入條件為：於彰化基督教醫院因結腸癌接受LRHC的病人，我們從彰化基督教醫院的病歷資料庫中收集患者數據。主要指標為術後短期預後，包括術中各項指標、以及術後併發症，次要指標包括復發率、總存活期（OS）及癌症特定存活期（CSS）。使用卡方檢定、t檢定、費雪檢定及曼-惠特尼U檢定比較各組之間的差異。我們也透過Cox回歸分析研究各變數與OS及CSS之間的關聯。研究結果：我們收集了240名患者的數據（ICA組61名，ECA組179名），平均年齡65.0歲，追蹤期中位數49.3個月。兩組患者特徵無顯著差異。ICA組的手術時間顯著較短（中位數（IQR）：120（110-155）vs. 150（130-180）分鐘）及失血量較少（中位數（IQR）：30（10-30）vs. 30（30-50）毫升）（p<0.001）。兩組在30天再住院（ECA vs. ICA：2.2% vs. 1.6%，p>0.999）或復發（ECA vs. ICA：13.4% vs. 18.0%，p=0.377）無顯著差異。多變量分析顯示兩組在OS（調整後風險比 [aHR]：0.87；95%信賴區間 [CI]：0.35-1.89）或CSS（調整後子風險比 [aSHR]：0.79，95% CI：0.22-2.75）上並無顯著差異。。結論：無論是ICA還是ECA，在LRHC治療結腸癌中的結果相似，且在術後併發症、30天再住院率、復發率和長期生存結果上均無統計學顯著差異。然而，ICA在手術時間較短和減少失血方面可能具有優勢。關鍵詞: 腹腔鏡右半結腸切除術（LRHC）；結腸癌；體內吻合（ICA）；體外吻合（ECA）

AbstractObjective：Laparoscopic right hemicolectomy (LRHC) is a widely performed surgery for patients with colon cancer, with surgeons selecting either intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA). The impact of choosing between ICA and ECA on patient outcomes remains a topic of ongoing discussion. Moreover, variations in surgeon expertise could influence these outcomes. This study aimed to evaluate and compare the short- and long-term outcomes of LRHC with ICA versus ECA.Methods and Materials：This retrospective analysis utilized data from the medical records of Changhua Christian Hospital, Taiwan, spanning from 2017 to 2020. Patients diagnosed with colon cancer who underwent LRHC, either with ICA or ECA, were included. Primary outcomes focused on post-operative results, while secondary outcomes included recurrence rates, overall survival (OS), and cancer-specific survival (CSS). Statistical comparisons between groups were conducted using chi-square tests, t-tests, Fisher’s exact tests, and Mann–Whitney U tests. Cox regression analyses were used to explore the associations between study variables, OS, and CSS.Results：Data from 240 patients (61 in the ICA group and 179 in the ECA group) were analyzed, with an average patient age of 65.0 years and a median follow-up time of 49.3 months. There were no significant differences in patient characteristics between the two groups. The ICA group had a significantly shorter median operation time (120 minutes [IQR: 110–155] vs. 150 minutes [IQR: 130–180], p < 0.001) and experienced less blood loss (30 mL [IQR: 10–30] vs. 30 mL [IQR: 30–50], p < 0.001) compared to the ECA group. No significant differences were observed in 30-day readmission rates (1.6% for ICA vs. 2.2% for ECA, p > 0.999) or recurrence rates (18.0% vs. 13.4%, p = 0.377). Multivariate Cox analyses found no statistically significant differences in OS (aHR: 0.65; 95% CI: 0.25–1.44) or CSS (aSHR: 0.41; 95% CI: 0.10–1.66).Conclusion：Both ICA and ECA for LRHC in patients with colon cancer showed comparable results in terms of short- and long-term outcomes. There were no statistically significant differences in post-operative complications, 30-day readmissions, recurrence rates, or survival outcomes. However, ICA appeared to offer advantages, including shorter operative time and less blood loss during surgery.Key words：Laparoscopic right hemicolectomy (LRHC); colon cancer; intracorporeal anastomosis (ICA); extracorporeal anastomosis (ECA)