Department of Colorectal Surgery, Hillerod Hospital, Denmark.
Colorectal Dis. 2011 Oct;13(10):1123-9. doi: 10.1111/j.1463-1318.2010.02474.x.
we analysed the influence of standardization of colon cancer surgery with complete mesocolic excision (CME) on the quality of surgery measured by the pathological end-points of number of harvested lymph nodes, high tie of supplying vessels, plane of mesocolic resection and rate of R0 resection.
One hundred and ninety-eight patients with colonic carcinoma who underwent radical surgery between September 2007 and February 2009 were divided into two groups, including those undergoing surgery before (93) or after (105) 1 June 2008, when complete mesocolic excision (CME) was introduced as standard in our hospital.
The overall mean high tie increased from 7.1 (CI, 6.5-7.6) to 9.6 (8.9-10.3) cm (P<0.0001) and the mean number of harvested lymph nodes from 24.5 (22.8-26.2) to 26.7 (24.6-28.8) (P=0.0095). There were no significant increases in these end-points in open right hemicolectomy, and in laparoscopic sigmoid resection the number of lymph nodes did not increase significantly. The plane of mesocolic resection, the rate of R0 resection and the risk of complications did not change significantly. The median (range) length of hospital stay increased from 4 (2-62) to 5 (2-71) days (P=0.04).
Standardization of colonic cancer surgery with CME seems to improve the quality of surgery without increasing the risk of complications.
我们分析了结肠癌手术规范化（完全结肠系膜切除术，CME）对以病理终点（淋巴结检出数目、供应血管高位结扎、结肠系膜平面和 R0 切除率）衡量的手术质量的影响。
198 例接受根治性手术的结肠癌患者，分为两组：2007 年 9 月至 2009 年 2 月接受手术（93 例），以及 2008 年 6 月 1 日 CME 成为我院标准术式后（105 例）接受手术。
总体而言，高位结扎的平均长度从 7.1cm（CI，6.5-7.6）增加至 9.6cm（8.9-10.3）（P<0.0001），淋巴结检出数目从 24.5 个（22.8-26.2）增加至 26.7 个（24.6-28.8）（P=0.0095）。开放右半结肠切除术的这些终点没有显著增加，腹腔镜乙状结肠切除术的淋巴结数量也没有显著增加。结肠系膜平面、R0 切除率和并发症风险没有显著变化。住院时间中位数（范围）从 4 天（2-62）增加至 5 天（2-71）（P=0.04）。
CME 规范化结肠癌手术似乎提高了手术质量，而不增加并发症风险。
