Siani L M, Pulica C
Department of Surgery, Unit of General Surgery, Azienda Ospedaliera "Carlo Poma," Mantua, Italy
Department of Surgery, Unit of General Surgery, Azienda Ospedaliera "Carlo Poma," Mantua, Italy.
Scand J Surg. 2015 Dec;104(4):219-26. doi: 10.1177/1457496914557017. Epub 2014 Nov 12.
To analyze our experience in translating the concept of total mesorectal excision to "no-touch" complete removal of an intact mesocolonic envelope (complete mesocolic excision), along with central vascular ligation and apical node dissection, in the surgical treatment of right-sided colonic cancers, comparing "mesocolic" to less radical "non-mesocolic" planes of surgery in respect to quality of the surgical specimen and long-term oncologic outcome.
A total of 115 patients with right-sided colonic cancers were retrospectively enrolled from 2008 to 2013 and operated on following the intent of minimally invasive complete mesocolic excision with central vascular ligation.
Morbidity and mortality were 22.6% and 1.7%, respectively. Mesocolic, intramesocolic, and muscularis propria planes of resection were achieved in 65.2%, 21.7%, and 13% of cases, respectively, with significant impact for mesenteric plane of surgery on R0 resection rate (97.3%), circumferential resection margin <1 mm (2.6%), and consequent survival advantage (82.6% at 5 years) when compared to muscularis propria plane of surgery, with R0 resection rate and overall survival falling to 72% and 60%, respectively, and with circumferential resection margin <1 mm raising to 33.3%, all being statistically significant. Stratifying patients for stage of disease, laparoscopic complete mesocolic excision with central vascular ligation significantly impacted survival in patients with stage II, IIIA/B, and in a subgroup of IIIC patients with negative apical nodes.
In our experience, minimally invasive complete mesocolic excision with central vascular ligation allows for both safety and higher quality of surgical specimens when compared to less radical intramesocolic or muscularis propria planes of "standard" surgery, significantly impacting loco-regional control and thus overall survival.
分析我们在将全直肠系膜切除的概念转化为“非接触”完整切除完整的结肠系膜包膜（完整结肠系膜切除），并结合中央血管结扎和顶端淋巴结清扫，用于右侧结肠癌手术治疗中的经验，比较“结肠系膜”手术平面与根治性较低的“非结肠系膜”手术平面在手术标本质量和长期肿瘤学结局方面的差异。
回顾性纳入2008年至2013年期间共115例右侧结肠癌患者，并按照微创完整结肠系膜切除并中央血管结扎的意图进行手术。
发病率和死亡率分别为22.6%和1.7%。分别有65.2%、21.7%和13%的病例实现了结肠系膜、结肠系膜内和固有肌层平面的切除，与固有肌层手术平面相比，手术的肠系膜平面对R0切除率（97.3%）、环周切缘<1mm（2.6%）以及随之而来的生存优势（5年时为82.6%）有显著影响，而固有肌层手术平面的R0切除率和总生存率分别降至72%和60%，环周切缘<1mm的比例升至33.3%，所有这些均具有统计学意义。根据疾病分期对患者进行分层，腹腔镜完整结肠系膜切除并中央血管结扎对II期、IIIA/B期以及IIIC期顶端淋巴结阴性的亚组患者的生存有显著影响。
根据我们的经验，与根治性较低的“标准”手术的结肠系膜内或固有肌层平面相比，微创完整结肠系膜切除并中央血管结扎既能保证安全性，又能提高手术标本质量，对局部区域控制进而对总生存有显著影响。
