右半结肠癌根治术中淋巴结检出数：开放手术、腹腔镜手术与机器人手术的比较。
Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches.
机构信息
Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
Colorectal Dis. 2017 Oct;19(10):888-894. doi: 10.1111/codi.13786.
AIM
Studies have demonstrated a relationship between lymph node (LN) yield and survival after colectomy for cancer. The impact of surgical technique on LN yield has not been well explored.
METHOD
This is a retrospective study of right colectomy (RC) for cancer at a single institution from 2012 to 2014. Exclusion criteria were previous colectomy and emergent and palliative operations. All data were collected by chart review. Primary outcomes were LN yield and the LN to length of surgical specimen (LN-LSS) ratio. Multivariable mixed models were created with surgeon and pathologist as random effects. Sensitivity analyses were performed to exclude Stage IV cancers and to analyse groups on an 'as-treated' basis.
RESULTS
We identified 181 open (O-RC), 163 laparoscopic (L-RC) and 119 robotic (R-RC) right colectomies. O-RC was more commonly performed in women with metastatic disease. The mean LN yield was 28, 29 and 34 in O-RC, L-RC and R-RC, respectively; the respective mean LN-LSS ratios were 0.83, 0.91 and 1.0. The R-RC approach produced a higher LN yield than the other approaches (P < 0.01), and a higher LN-LSS ratio than O-RC (P < 0.01). These findings were unchanged in sensitivity analyses.
CONCLUSION
Robotic right colectomy improves LN yield and the LN-LSS ratio, which may reflect better mesocolic excision. The effect of these findings on survival requires further investigation.
目的
研究表明，淋巴结（LN）产量与癌症根治性结肠切除术的生存之间存在关联。但外科技术对 LN 产量的影响尚未得到充分探讨。
方法
这是对 2012 年至 2014 年在一家机构进行的右半结肠癌切除术（RC）的回顾性研究。排除标准为既往结肠切除术和急诊及姑息性手术。所有数据均通过病历回顾收集。主要结局指标为 LN 产量和 LN 与手术标本长度（LN-LSS）之比。使用外科医生和病理学家作为随机效应创建多变量混合模型。进行敏感性分析以排除 IV 期癌症，并对按“实际处理”分组进行分析。
结果
共确定了 181 例开腹（O-RC）、163 例腹腔镜（L-RC）和 119 例机器人（R-RC）右半结肠切除术。O-RC 更多地用于患有转移性疾病的女性。O-RC、L-RC 和 R-RC 的平均 LN 产量分别为 28、29 和 34，相应的平均 LN-LSS 比值分别为 0.83、0.91 和 1.0。与其他方法相比，R-RC 方法产生的 LN 产量更高（P<0.01），并且 LN-LSS 比值也更高（P<0.01）。在敏感性分析中，这些发现保持不变。
结论
机器人右半结肠切除术提高了 LN 产量和 LN-LSS 比值，这可能反映了更好的横结肠系膜切除。这些发现对生存的影响需要进一步研究。
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