Lee Kyung Ha, Kim Jin Soo, Kim Ji Yeon
Department of Surgery, Chungnam National University Hospital, Daejeon, Korea.
Ann Surg Treat Res. 2018 Apr;94(4):209-215. doi: 10.4174/astr.2018.94.4.209. Epub 2018 Mar 26.
There is no standard consensus for the ligation level of the inferior mesenteric artery during radical resection of sigmoid colon cancer. Especially, there is little research about low ligation combined with D3 dissection. The study was performed to compare feasibility and oncologic safety between low ligation with D3 dissection to high ligation in intermediately advanced sigmoid colon cancer.
From January 2008 to December 2013, 134 patients who underwent radical surgery for cT3N0M0 sigmoid colon cancer were evaluated retrospectively. Clinicopathologic factors and oncologic outcomes of high ligation (HL, n = 51) and low ligation (LL, n = 83) groups were compared.
The mean operative time was significantly shorter in LL, and there was no difference in complications, distal margin or number of retrieved lymph node. The tumor size was significantly larger in HL, but there was no difference in number of metastatic lymph node, pT or pN stage. There was no difference in overall survival, disease-free survival, or local and systemic recurrence.
In cT3N0M0 sigmoid colon cancers, we suggest that low ligation with D3 dissection can be performed with feasibility and oncological safety.
在乙状结肠癌根治性切除术中，对于肠系膜下动脉的结扎水平尚无标准共识。尤其是，关于低位结扎联合D3清扫的研究很少。本研究旨在比较中度进展期乙状结肠癌行低位结扎联合D3清扫与高位结扎的可行性和肿瘤学安全性。
回顾性评估2008年1月至2013年12月期间134例行cT3N0M0乙状结肠癌根治性手术的患者。比较高位结扎组（HL，n = 51）和低位结扎组（LL，n = 83）的临床病理因素和肿瘤学结局。
LL组的平均手术时间明显更短，并发症、远端切缘或回收淋巴结数量无差异。HL组的肿瘤大小明显更大，但转移淋巴结数量、pT或pN分期无差异。总生存期、无病生存期或局部及全身复发无差异。
对于cT3N0M0乙状结肠癌，我们建议低位结扎联合D3清扫具有可行性和肿瘤学安全性。
