Honaker Michael, Scouten Samantha, Sacksner Jordy, Ziegler Matthew, Wasvary Harry
William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI, USA.
Int J Colorectal Dis. 2016 Mar;31(3):631-4. doi: 10.1007/s00384-015-2499-9. Epub 2016 Jan 22.
Studies have shown improved survival with increasing amounts of harvested lymph nodes. The purpose of this study was to evaluate two laparoscopic techniques to right colectomy, laparoscopic medial to lateral (MtL) approach and laparoscopic lateral to medial (LtM) approach, in patients undergoing a right colectomy for either endoscopically unresectable polyps or carcinoma and determine which technique offers the optimal lymph node harvest.
Patients that underwent a laparoscopic right colectomy over a 5-year period were identified. Charts were reviewed with regards to demographics, surgical approach, length of stay (LOS) and number of lymph nodes harvested. Variables were statistically analyzed and outcomes compared between the two groups. A p value of less than 0.05 was considered statistically significant.
Two hundred thirty-three patients underwent a laparoscopic right colectomy over a 5-year period for endoscopically unresectable polyps or carcinoma. Seventy-nine patients underwent a MtL approach and 154 patients underwent a LtM approach. When comparing the two groups, there were more females in the MtL group relative to the LtM group (78% vs 66%; p = 0.0015). When the outcome of number of lymph nodes harvested was examined, there was a significantly larger number of nodes harvested in the MtL (median = 24) approach compared to the LtM approach (median = 19; p = 0.0002). LOS was similar between the MtL and LtM group (median 4 days for both).
The laparoscopic MtL approach to right colectomy yields a larger lymph node harvest compared to the laparoscopic LtM approach.
研究表明，收获的淋巴结数量增加可提高生存率。本研究的目的是评估两种用于右半结肠切除术的腹腔镜技术，即腹腔镜由内侧向外侧（MtL）入路和腹腔镜由外侧向内侧（LtM）入路，用于因内镜下不可切除息肉或癌而接受右半结肠切除术的患者，并确定哪种技术能实现最佳的淋巴结收获量。
确定在5年期间接受腹腔镜右半结肠切除术的患者。回顾病历，了解患者的人口统计学资料、手术方式、住院时间（LOS）和收获的淋巴结数量。对变量进行统计学分析，并比较两组的结果。p值小于0.05被认为具有统计学意义。
在5年期间，233例患者因内镜下不可切除息肉或癌接受了腹腔镜右半结肠切除术。79例患者采用MtL入路，154例患者采用LtM入路。比较两组时，MtL组的女性患者比LtM组多（78%对66%；p = 0.0015）。在检查收获的淋巴结数量结果时，与LtM入路（中位数 = 19；p = 0.0002）相比，MtL入路（中位数 = 24）收获的淋巴结数量明显更多。MtL组和LtM组的住院时间相似（两组中位数均为4天）。
与腹腔镜LtM入路相比，腹腔镜MtL入路进行右半结肠切除术可收获更多的淋巴结。
