■原著
当科における進行大腸癌に対する腹腔鏡手術の現況―適応と除外因子の検討
鈴木 英之, 古川 清憲, 菅 隼人, 鶴田 宏之, 松本 智司, 秋谷 行宏, 松田 明久, 進士 誠一, 佐々木 順平, 田尻 孝
日本医科大学大学院医学研究科臓器病態制御外科学
Laparoscopic Surgery for Advanced Colorectal Cancer: Selection Criteria and Exclusion Factors in our department
Hideyuki Suzuki, Kiyonori Furukawa, Hayato Kan, Hiroyuki Tsuruta, Satoshi Matsumoto, Yukihiro Akiya, Akihisa Matsuda, Seiichi Shinji, Junpei Sasaki and Takashi Tajiri
Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
Introduction: Laparoscopic assisted colectomy (LAC) for early colorectal cancer has been established and been proven to be equivalent to open colectomy in terms of survival and safety. Although the indications for LAC in advanced colorectal cancer remain controversial, LAC has been performed increasingly often.
Purpose: To clarify the selection criteria of laparoscopic surgery for advanced colorectal cancer.
Methods: The indications for laparoscopic surgery in advanced colorectal cancer were established from 2001∼2004, as: 1) the cecum, ascending colon, descending colon, sigmoid colon, and rectosigmoid colon, 2) tumor depth within the subserosa, 3) no regional lymph node involvement, and 4) no distant metastasis. Indications established from 2005 to 2007 were: 1) all colorectal cancer with none in the lower rectum, 2) no distant metastasis, and 3) no direct invasion to neighboring organs. The reasons to exclude indications and the exclusion factors for laparoscopic colectomy for advanced colorectal cancer were analyzed.
Results: The percentage of cases consistent with the indications were 55% (2001∼2004) and 78% (2005∼2007). The reasons for exclusion were liver metastasis (19% and 40%), tumor location (33% and 37%), direct invasion to the neighboring organs (21% and 17%), and peritoneal dissemination (3% and 6%). The exclusion factors for laparoscopic colectomy were tumor size (31% and 27%), synchronous malignancies (11% and 26%), ileus and emergencies (17% and 14%), history of previous abdominal surgery (15% and 14%), age and general condition (17% and 9%), and obesity (8% and 5%). There was no significant difference between the short-term performance of LAC from 2001∼2004 and from 2005 to 2007. Operation time, blood loss, conversion rate to open surgery and postoperative complications were similar between the patients with a body mass index (BMI) less than 25 and those with a body mass index greater than 25.
Conclusion: Practical indications for LAC in advanced colorectal cancer are 1) all colorectal cancer with none in the lower rectum, 2) no distant metastasis, and 3) no direct invasion to neighbouring organs. Obesity is not necessarily an exclusion factor for LAC. However long-term analysis is still necessary.
日医大医会誌 2008; 4(4), 181-188
Key words
laparoscopic colectomy, advanced colon cancer, surgical indication, obesity
Correspondence to
Hideyuki Suzuki, Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendai, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail：pdd00576@nifty.ne.jp
受付：2008年5月8日 受理：2008年7月18日 |
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