Killeen S, Mannion M, Devaney A, Winter D C
Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland.
Colorectal Dis. 2014 Aug;16(8):577-94. doi: 10.1111/codi.12616.
Complete mesocolic excision (CME) and extended lympha-denectomy (EL) have been proposed as safe procedures for improving colon cancer survival outcomes. The aim of this study was to evaluate the evidence regarding oncological outcomes, morbidity and mortality after such techniques for colon cancer.
A systematic review of the literature was conducted to evaluate evidence regarding oncological outcomes, morbidity and mortality after CME or EL. Three major databases (PubMed, MEDLINE and the Cochrane Library) were searched. The review included original articles reporting outcomes after CME or EL from January 1950 to July 2012.
Twenty-one, predominately retrospective, studies involving 5246 patients (mean age 68.2 years, 56.5% men) were included. Reporting of outcomes was inconsistent. Median follow up was 60 months. The operative mortality rate was 3.2% and the cumulative morbidity rate was 21.5%. The weighted mean local recurrence rate and the 5-year overall and disease-free survival rates were 4.5%, 58.1% and 77.4%, respectively.
The available data for CME and EL have numerous fundamental limitations that prohibit adoption. Contemporary controlled studies are required before universal recommendation.
完整结肠系膜切除术（CME）和扩大淋巴结清扫术（EL）已被提出作为改善结肠癌生存结局的安全手术。本研究的目的是评估此类结肠癌手术技术在肿瘤学结局、发病率和死亡率方面的证据。
对文献进行系统回顾，以评估CME或EL术后在肿瘤学结局、发病率和死亡率方面的证据。检索了三个主要数据库（PubMed、MEDLINE和Cochrane图书馆）。该综述纳入了1950年1月至2012年7月间报告CME或EL术后结局的原始文章。
纳入了21项研究，主要为回顾性研究，涉及5246例患者（平均年龄68.2岁，男性占56.5%）。结局报告不一致。中位随访时间为60个月。手术死亡率为3.2%，累积发病率为21.5%。加权平均局部复发率以及5年总生存率和无病生存率分别为4.5%、58.1%和77.4%。
CME和EL的现有数据存在许多基本局限性，无法采用。在普遍推荐之前，需要进行当代对照研究。
