Mori Shinichiro, Kita Yoshiaki, Baba Kenji, Yanagi Masayuki, Tanabe Kan, Uchikado Yasuto, Kurahara Hiroshi, Arigami Takaaki, Uenosono Yoshikazu, Mataki Yuko, Nakajo Akihiro, Maemura Kosei, Natsugoe Shoji
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan.
Surg Today. 2018 Mar;48(3):274-281. doi: 10.1007/s00595-017-1580-0. Epub 2017 Aug 23.
To evaluate the safety and feasibility of laparoscopic complete mesocolic excision (CME) via mesofascial separation for left-sided colon cancer.
We evaluated prospectively collected data on 65 consecutive patients with stage I-III left-sided colon cancer, who underwent laparoscopic CME between October 2011 and September 2016. After the exclusion of 5 patients who had T4b or other active tumors, 60 patients were the subjects of this analysis. The completeness of CME, preservation of the hypogastric nerve, operative data, pathological findings, complications, and length of hospital stay were assessed.
CME completeness was graded as the mesocolic and intramesocolic plane in 54 and 6 patients, respectively. The hypogastric nerve was preserved in all patients. A total of 17, 12, 28, and 3 patients had T1, T2, T3, and T4a tumors, respectively. The mean number of lymph nodes retrieved was 16.2, and lymph node metastasis was identified in 22 patients. The mean operative time and intraoperative blood loss were 283 min and 38 ml, respectively. One patient had an intraoperative complication and six patients had postoperative complications. The hospital stay was 12 days.
Laparoscopic CME via mesofascial separation is a safe and feasible procedure for left-sided colon cancer.
评估经筋膜分离的腹腔镜完整结肠系膜切除术（CME）治疗左侧结肠癌的安全性和可行性。
我们前瞻性评估了2011年10月至2016年9月期间连续接受腹腔镜CME的65例I-III期左侧结肠癌患者的收集数据。排除5例T4b或其他活动性肿瘤患者后，60例患者作为本分析的对象。评估CME的完整性、下腹神经的保留情况、手术数据、病理结果、并发症及住院时间。
CME完整性分别在54例和6例患者中被分级为结肠系膜平面和结肠系膜内平面。所有患者下腹神经均得以保留。分别有17例、12例、28例和3例患者患有T1、T2、T3和T4a肿瘤。平均获取淋巴结数为16.2个，22例患者发现有淋巴结转移。平均手术时间和术中失血量分别为283分钟和38毫升。1例患者发生术中并发症，6例患者发生术后并发症。住院时间为12天。
经筋膜分离的腹腔镜CME是治疗左侧结肠癌的一种安全可行的手术方法。
