通过外科教育计划提高结肠癌手术质量。

Improving the quality of colon cancer surgery through a surgical education program.

机构信息

Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, Leeds, United Kingdom.

出版信息

Dis Colon Rectum. 2010 Dec;53(12):1594-603. doi: 10.1007/DCR.0b013e3181f433e3.

DOI:10.1007/DCR.0b013e3181f433e3

PMID:21178852

Abstract

PURPOSE

Recent evidence has demonstrated the importance of dissection in the correct tissue plane for the resection of colon cancer. We have previously shown that meticulous mesocolic plane surgery yields better outcomes and that the addition of central vascular ligation produces an oncologically superior specimen compared with standard techniques. We aimed to assess the effect of surgical education on the oncological quality of the resection specimen produced.

METHODS

We received clinicopathological data and specimen photographs from 263 resections for primary colon cancer from 6 hospitals in the Capital and Zealand regions of Denmark before a national training program. Ninety-three cases were from Hillerød Hospital, where surgeons had previously implemented a surgical educational training program in complete mesocolic excision with central vascular ligation and adopted the procedure as standard practice. The specimen photographs were assessed for the plane of surgery and tissue morphometry was performed.

RESULTS

Hillerød specimens had a higher rate of mesocolic plane surgery (75% vs 48%; P < .0001) compared with the other hospitals. The surgeons at Hillerød Hospital also removed a greater length of colon in both fresh (median, 315 vs 247 mm; P < .0001) and fixed (269 vs 207 mm; P < .0001) specimens with a greater distance between the tumor and the closest vascular tie in both fresh (105 vs 84 mm; P = .006) and fixed (82 vs 67 mm; P = .002) specimens. This resulted in the removal of more mesentery in both fresh (14,466 vs 8706 mm; P < .0001) and fixed (9418 vs 6789 mm; P < .0001) specimens and a greater median lymph node yield (28 vs 18; P < .0001).

CONCLUSIONS

We have shown that adoption of complete mesocolic excision with central vascular ligation results in a change to the production of an oncologically superior specimen compared with standard techniques. This should improve outcomes toward those reported by centers that have long practiced meticulous colon cancer surgery.

摘要

目的

最近的证据表明，在正确的组织平面上进行结肠癌的解剖对于切除肿瘤至关重要。我们之前已经表明，精细的结肠系膜平面手术可以带来更好的结果，并且与标准技术相比，中央血管结扎的加入可以产生具有更好肿瘤学效果的标本。我们旨在评估手术教育对切除标本肿瘤学质量的影响。

方法

在丹麦首都地区和西兰地区的 6 家医院实施全国培训计划之前，我们从 263 例原发性结肠癌的临床病理数据和标本照片中获得了信息。93 例来自于希勒勒医院，该医院的外科医生之前在完全结肠系膜切除术中实施了手术教育培训计划，并将该程序作为标准实践。评估了标本照片的手术平面，并进行了组织形态计量学检查。

结果

与其他医院相比，希勒勒医院的标本中结肠系膜平面手术的比例更高（75%比 48%；P<0.0001）。希勒勒医院的外科医生在新鲜和固定标本中切除的结肠长度也更长（中位数分别为 315 毫米和 247 毫米；P<0.0001），肿瘤与最近的血管结扎之间的距离也更大（新鲜标本为 105 毫米和 84 毫米；P=0.006，固定标本为 82 毫米和 67 毫米；P=0.002）。这导致新鲜和固定标本中肠系膜切除量更大（新鲜标本为 14466 毫米和 8706 毫米；P<0.0001，固定标本为 9418 毫米和 6789 毫米；P<0.0001），以及更多的中位淋巴结收获（28 个和 18 个；P<0.0001）。