Kontovounisios C, Kinross J, Tan E, Brown G, Rasheed S, Tekkis P
Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.
Colorectal Dis. 2015 Jan;17(1):7-16. doi: 10.1111/codi.12793.
Several studies have suggested an increased lymph node yield, reduced locoregional recurrence and increased disease-free survival after complete mesocolic excision (CME) for colorectal cancer. This review was undertaken to assess the use of CME for colon cancer by evaluating the technique and its clinical outcome.
A literature search of publications was performed using PubMed and Medline. Only studies published in English were included. Studies assessed for quality and data were extracted by two independent reviewers. End-points included number of lymph nodes per patient, quality of the plane of mesocolic excision, postoperative mortality and morbidity, 5-year locoregional recurrence and 5-year cancer-specific survival.
There were 34 articles comprising 12 retrospective studies, nine prospective studies and 13 original articles including case series, observational studies and editorials. Of the prospective studies, four reported an increased lymph node harvest and a survival benefit. The others reported an improvement in the quality of the specimen as assessed by histopathological examination. Laparoscopic CME has the same oncological outcome as open surgery but completeness of excision during laparoscopy may be compromised for tumours in the transverse colon.
Studies demonstrate that CME removes significantly more tissue around the tumour including maximal lymph node clearance. There is little information on serious adverse events after CME and a long-term survival benefit has not been proved.
多项研究表明，结直肠癌行完整结肠系膜切除术（CME）后，淋巴结获取数量增加，局部区域复发减少，无病生存期延长。本综述旨在通过评估CME技术及其临床结果，来评价其在结肠癌治疗中的应用。
使用PubMed和Medline对出版物进行文献检索。仅纳入以英文发表的研究。由两名独立的审阅者对研究进行质量评估并提取数据。终点指标包括每位患者的淋巴结数量、结肠系膜切除平面的质量、术后死亡率和发病率、5年局部区域复发率以及5年癌症特异性生存率。
共有34篇文章，包括12项回顾性研究、9项前瞻性研究以及13篇原创文章，后者包括病例系列、观察性研究和社论。在前瞻性研究中，4项报告了淋巴结获取数量增加及生存获益。其他研究报告了经组织病理学检查评估的标本质量有所改善。腹腔镜CME与开放手术具有相同的肿瘤学结局，但对于横结肠癌，腹腔镜手术期间的切除完整性可能会受到影响。
研究表明，CME能显著切除肿瘤周围更多组织，包括最大程度的淋巴结清扫。关于CME术后严重不良事件的信息较少，且尚未证实其具有长期生存获益。
