Hussain Anwar, Mahmood Fahad, Torrance Andrew W, Tsiamis Achilleas
Department of Surgery, University Hospital North Midlands, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Ann Med Surg (Lond). 2017 Dec 28;26:19-23. doi: 10.1016/j.amsu.2017.12.011. eCollection 2018 Feb.
Laparoscopic surgery is the favoured method of colorectal cancer resections. It is surgeon expertise and discretion to choose whether to mobilize colon lateral-to-medial or medial-to-lateral. We aim to identify the advantage of one approach over the other in short-term and cancerrelated outcomes.
A retrospective review of a prospectively maintained database of all laparoscopic colorectal resections with curative-intent, in a single unit, from March 2013 to October 2014. Data was collected on patient demographics, method of laparoscopic mobilisation, operating time, length-of-stay, post-operative complications, clearance of circumferential resection margins lymph node harvest and follow-up.
137 patients with comparable patient demographics had laparoscopic colorectal cancer resection. 76 (60.3%) male and 50 (39.7%) female patients. 58(46.0%) of resections were performed using medial-to-lateral approach, while 68(54.0%) lateral-to-medial. Lateral group had on average 14(0-38) lymph nodes with specimen compared to 17 (6-45) in medial group. There was a statistically significant difference in the major complication rate (Clavien-Dindo IV) between the groups with 1(1.7%) in the medial-to-lateral group compared to 7 (10.2%) in the lateral-to-medial group, (p .035). Patients in the medial-to-lateral group had median length-of-stay of 7 days (range 2-55) compared to 7 days (range 2-75) in the lateral-to-medial group. There was no statistically significant difference in survival between both groups up-to 1334 days p=.413.
Our study shows that mobilising the colon medially in laparoscopic colorectal cancer resection increases the lymph node harvest, gives comparable CRM clearance, similar length of hospital stay and complications. It makes no statistically significant difference in the overall patient survival.
腹腔镜手术是结直肠癌切除术的首选方法。选择从外侧向内侧还是从内侧向外侧游离结肠由外科医生的专业知识和判断决定。我们旨在确定两种方法在短期和癌症相关结局方面的优势。
对2013年3月至2014年10月在单一科室进行的所有具有治愈意图的腹腔镜结直肠癌切除术的前瞻性维护数据库进行回顾性分析。收集患者人口统计学数据、腹腔镜游离方法、手术时间、住院时间、术后并发症、环周切缘清除情况、淋巴结清扫情况及随访数据。
137例具有可比人口统计学特征的患者接受了腹腔镜结直肠癌切除术。男性76例（60.3%），女性50例（39.7%）。58例（46.0%）切除术采用从内侧向外侧的方法，而68例（54.0%）采用从外侧向内侧的方法。外侧组标本平均有14个（0 - 38个）淋巴结，内侧组为17个（6 - 45个）。两组间主要并发症发生率（Clavien-Dindo IV级）有统计学显著差异，从内侧向外侧组为1例（1.7%），从外侧向内侧组为7例（10.2%），（p = 0.035）。从内侧向外侧组患者的中位住院时间为7天（范围2 - 55天），从外侧向内侧组为7天（范围2 - 75天）。两组在1334天内的生存率无统计学显著差异，p = 0.413。
我们的研究表明，在腹腔镜结直肠癌切除术中从内侧游离结肠可增加淋巴结清扫数量，环周切缘清除情况相当，住院时间和并发症相似。在总体患者生存率方面无统计学显著差异。
