Division of Surgical Oncology, F. Magrassi-A. Lanzara" Department of Clinical and Experimental Medicine and Surgery, School of Medicine, Second University of Naples, c/o II Policlinico, Edificio 17 Via Pansini, 5, 80131, Naples, Italy,
Int J Colorectal Dis. 2014 Jan;29(1):89-97. doi: 10.1007/s00384-013-1766-x. Epub 2013 Aug 28.
Complete mesocolic excision (CME) with central vascular ligation (CVL) has been proposed for treatment of colon cancers based on the same principles as total mesorectal excision. Impressive outcomes have been reported, however, direct comparisons with the classic procedure are lacking.
Forty-five consecutive patients operated on in the last 5 years with CME and CVL right hemicolectomy entered the study. Fifty-eight right-sided colon cancer patients operated in the previous 5 years with classic approach constituted the control group. Intra- and postoperative course assessed the safety of the procedure. Primary end-points for oncological adequacy were recurrence and survival rate.
All operations were successful with no increase in postoperative complications (p = 0.85). Number of harvested nodes and length of vascular ligation were shown to be significantly better in the CME group (p < 0.01). A higher number of tumor deposits were harvested thus allowing chemotherapy in newly upstaged patients. Locoregional recurrences were never experienced in CME patients (p = 0.03). The risk of cancer-related death was reduced by over one half in all CME patients, and even by three quarters in node-positive tumors. The classic operation was significantly associated with poor outcome (p < 0.01).
This study shows that CME with CVL is a safe and effective surgical approach for right colon cancer, thus confirming the previously reported oncological adequacy. The procedure was shown to significantly decrease local recurrences and to improve the survival rate, particularly in node-positive patients. Urgent diffusion of this technique is warranted.
基于全直肠系膜切除术的相同原理，提出了完整结肠系膜切除术（CME）联合中央血管结扎（CVL）治疗结肠癌。虽然已经报道了令人印象深刻的结果，但缺乏与经典手术的直接比较。
在过去 5 年中，我们对 45 例接受 CME 和 CVL 右半结肠切除术的连续患者进行了研究。在过去 5 年中，我们对 58 例接受经典方法治疗的右侧结肠癌患者进行了对照研究。评估了手术的安全性和术后情况。评估肿瘤学充分性的主要终点是复发率和生存率。
所有手术均成功完成，术后并发症无增加（p=0.85）。CME 组的淋巴结采集数量和血管结扎长度明显更好（p<0.01）。因此，更多的肿瘤沉积物被采集，从而使新分期的患者能够接受化疗。CME 患者从未发生局部区域复发（p=0.03）。所有 CME 患者的癌症相关死亡风险降低了一半以上，而淋巴结阳性肿瘤的风险降低了四分之三以上。经典手术与不良预后显著相关（p<0.01）。
这项研究表明，CME 联合 CVL 是治疗右半结肠癌的一种安全有效的手术方法，因此证实了先前报道的肿瘤学充分性。该手术可显著降低局部复发率，并提高生存率，特别是在淋巴结阳性患者中。迫切需要推广这种技术。
