Bokey L, Chapuis P H, Chan C, Stewart P, Rickard M J F X, Keshava A, Dent O F
Department of Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.
School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia.
Colorectal Dis. 2016 Jul;18(7):676-83. doi: 10.1111/codi.13159.
Complete mesocolic excision (CME) has been advocated as likely to improve the long-term oncological outcome of colon cancer resection, although there is a paucity of long-term results in the literature. The aim of this study was to supplement our previously published results on colon cancer resection based on a standardized technique of precise dissection along anatomical planes with high vascular ligation and to compare our long-term results with those of recent European studies of CME.
Data were drawn from a prospective hospital registry of consecutive resections for colon cancer between 1996 and 2007, including follow-up to the end of 2012. The principal outcomes from potentially curative resections were 5-year Kaplan-Meier rates of local recurrence, systemic recurrence, overall survival and cancer-specific survival. Secondary outcomes for all resections were postoperative complications, number of lymph nodes retrieved and R0 status.
For 779 potentially curative resections the local recurrence rate was 2.1% (95% CI 1.3-3.4), the systemic recurrence rate was 10.2% (95% CI 8.1-12.7), the 5-year overall survival rate was 76.2% (95% CI 73.0-79.0) and the cancer-specific survival rate was 89.8% (95% CI 87.3-91.9). For all 905 resections, rates of 14 surgical complications were low and not dissimilar to those in a comparable study. The median lymph node count was 15 (range 0-113). R0 status was confirmed in 883/905 patients (97.6%; 95% CI 96.4-98.5).
For colon cancer, meticulous dissection along anatomical planes together with high vascular ligation results in few complications, a high R0 rate, low recurrence and high survival.
尽管文献中缺乏长期结果，但完整结肠系膜切除术（CME）已被提倡，认为其可能改善结肠癌切除的长期肿瘤学结局。本研究的目的是补充我们之前发表的基于沿解剖平面精确解剖、高血管结扎的标准化技术进行结肠癌切除的结果，并将我们的长期结果与近期欧洲关于CME的研究结果进行比较。
数据来自1996年至2007年间结肠癌连续切除术的前瞻性医院登记处，包括随访至2012年底。潜在根治性切除术的主要结局是局部复发、全身复发、总生存和癌症特异性生存的5年Kaplan-Meier率。所有切除术的次要结局是术后并发症、获取的淋巴结数量和R0状态。
对于779例潜在根治性切除术，局部复发率为2.1%（95%CI 1.3 - 3.4），全身复发率为10.2%（95%CI 8.1 - 12.7），5年总生存率为76.2%（95%CI 73.0 - 79.0），癌症特异性生存率为89.8%（95%CI 87.3 - 91.9）。对于所有905例切除术，14种手术并发症的发生率较低，与一项可比研究中的发生率没有差异。淋巴结计数中位数为15（范围0 - 113）。883/905例患者（97.6%；95%CI 96.4 - 98.5）确认达到R0状态。
对于结肠癌，沿解剖平面细致解剖并进行高血管结扎导致并发症少、R0率高、复发率低且生存率高。
