Kobayashi Hirotoshi, West Nicholas P, Takahashi Keiichi, Perrakis Aristoteles, Weber Klaus, Hohenberger Werner, Quirke Philip, Sugihara Kenichi
Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo, Japan,
Ann Surg Oncol. 2014 Jun;21 Suppl 3:S398-404. doi: 10.1245/s10434-014-3578-9. Epub 2014 Feb 25.
A number of studies have demonstrated that lymph node metastasis is a poor prognostic factor in colon cancer. Advances of surgical procedure have improved the outcomes of colon cancer treatment. The aim of this study was to compare the characteristics of surgery for stage III colon cancer between England, Germany, and Japan.
Using the data of patients with colon cancer from one English, one German, and two Japanese centers, the characteristics of clinicopathologic features were compared. Conventional surgery, complete mesocolic excision (CME) with central vascular ligation, and D3 lymph node dissection were performed in England, Germany, and Japan, respectively.
Nineteen English, 26 German, and 60 Japanese patients were enrolled. There was no difference in tumor location, pT, and pN factors among the three groups. The length of resected bowel and the area of resected mesentery of the English and CME specimens were significantly greater than those of the D3 specimens (P < 0.0001 and P < 0.0001, respectively), whereas the length of the vascular tie to the bowel wall was similar between the CME and D3 specimens (P = 0.87), which was longer than that of the English specimens. The number of lymph nodes retrieved in the CME specimens was greatest among three groups (P < 0.0001), although the number of positive nodes was comparable (P = 0.64). The rates of mesocolic plane surgery in the English, CME, and D3 specimens were 47.4, 88.5, and 71.7 %, respectively (P = 0.022).
Three types of surgery for colon cancer differed in terms of the length of the resected bowel and the area of mesentery, although the length of the vascular tie to the bowel wall was similar between CME and D3 specimens. The high rates of mesocolic plane surgery were demonstrated in the CME and D3 specimens.
多项研究表明，淋巴结转移是结肠癌预后不良的因素。外科手术的进展改善了结肠癌的治疗效果。本研究的目的是比较英国、德国和日本III期结肠癌的手术特点。
利用来自一个英国、一个德国和两个日本中心的结肠癌患者数据，比较临床病理特征。英国、德国和日本分别进行了传统手术、中央血管结扎的完整结肠系膜切除术（CME）和D3淋巴结清扫术。
纳入了19名英国患者、26名德国患者和60名日本患者。三组患者的肿瘤位置、pT和pN因素无差异。英国标本和CME标本的切除肠段长度和切除系膜面积显著大于D3标本（分别为P < 0.0001和P < 0.0001），而CME和D3标本与肠壁的血管结扎长度相似（P = 0.87），且长于英国标本。CME标本中获取的淋巴结数量在三组中最多（P < 0.0001），尽管阳性淋巴结数量相当（P = 0.64）。英国标本、CME标本和D3标本的结肠系膜平面手术率分别为47.4%、88.5%和71.7%（P = 0.022）。
结肠癌的三种手术方式在切除肠段长度和系膜面积方面存在差异，尽管CME和D3标本与肠壁的血管结扎长度相似。CME和D3标本的结肠系膜平面手术率较高。
