Department of Surgery, Haraldsplass Deaconess Hospital, University of Bergen, POB 6165, 5892, Bergen, Norway.
Tech Coloproctol. 2014 Jun;18(6):557-64. doi: 10.1007/s10151-013-1100-1. Epub 2013 Dec 20.
BACKGROUND: The aim of the present study was to investigate whether the new method of complete mesocolic excision (CME) with a high (apical) vascular tie (D3 resection) had an immediate effect compared with a conventional (standard) approach even in those patients without lymph node metastases. METHODS: A cohort of 189 consecutive patients with tumour-nodal-metastasis (TNM) stages I-II and a mean age of 73 years were operated on in the period from January 2007 to December 2008 in three community teaching hospitals. The CME approach (n = 89), used in hospital A, was compared to the standard technique used (n = 105) in two other hospitals, B and C. Lymph node yields from the specimens were used as a surrogate measure of radical resections. Outcome was analysed after a median follow-up of 50.2 months. RESULTS: In-hospital mortality rate was 2.8 % in the CME group and 8.6 % in the standard group. The 3-year overall survival (OS) in the CME group was 88.1 versus 79.0 % (p = 0.003) in the standard group, and the corresponding disease-free survival (DFS) was 82.1 versus 74.3 % (p = 0.026). Cancer-specific survival was 95.2 % in the CME group versus 90.5 % in the standard group (p = 0.067). Age, operative technique, and T category were significant in multiple Cox regressions of OS and DFS. CONCLUSIONS: Compared with the standard (D2) approach, introduction of CME surgical management of colon cancer resulted in a significant immediate improvement of 3-year survival for patients with TNM stage I-II tumours as assessed by OS and DFS.
背景：本研究的目的是探讨新的完整结肠系膜切除术（CME）方法，即高位（顶端）血管结扎（D3 切除术）与传统（标准）方法相比，即使在没有淋巴结转移的患者中，是否有即刻效果。
方法：在 2007 年 1 月至 2008 年 12 月期间，在 3 家社区教学医院中对 189 例肿瘤-淋巴结-转移（TNM）分期 I-II 期和平均年龄 73 岁的连续患者进行了手术。在医院 A 中使用 CME 方法（n=89），与另外两家医院 B 和 C 中使用的标准技术（n=105）进行了比较。标本中的淋巴结产量用作根治性切除术的替代指标。在中位随访 50.2 个月后分析结果。
结果：CME 组的院内死亡率为 2.8%，标准组为 8.6%。CME 组的 3 年总生存率（OS）为 88.1%，标准组为 79.0%（p=0.003），相应的无病生存率（DFS）为 82.1%，标准组为 74.3%（p=0.026）。CME 组的癌症特异性生存率为 95.2%，标准组为 90.5%（p=0.067）。在 OS 和 DFS 的多 Cox 回归中，年龄、手术技术和 T 分类是显著的。
结论：与标准（D2）方法相比，CME 手术治疗结肠癌可显著提高 TNM 分期 I-II 期患者的 3 年生存率，通过 OS 和 DFS 评估。
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