1 Division of Surgery, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden.
2 Division of Geriatric Medicine, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden.
Scand J Surg. 2019 Sep;108(3):227-232. doi: 10.1177/1457496918812198. Epub 2018 Nov 21.
The optimal extent of mesenteric resection in colon cancer surgery remains elusive. The aim was to assess the impact on perioperative morbidity and oncological outcome depending on the height of central vessel ligation in sigmoid resection for adenocarcinomas.
All cases of stage I-III sigmoid cancers, operated on with locally radical resections (2007-2009), were identified in the Swedish Colorectal Cancer Registry and categorized according to the position of the vascular ligature, that is, ligation of the inferior mesenteric artery, ligation of the superior rectal artery, or ligation of the sigmoid branches.
In total, 999 cases were identified and possible to categorize. Although higher ligation level yielded a higher number of lymph nodes, 3- or 5-year overall survival, 5-year disease-free survival, or recurrence rate did not differ between the groups (p = 0.79, p = 0.41, p = 0.67, p = 0.51). No differences in survival were detected after multivariate analysis adjusted for age, sex, T-stage, N-stage, American Society of Anesthesiologists classification, and adjuvant therapy.
This large population-based study showed increased lymph node yield but no survival benefit or any decreased recurrence rate by high tie in resection of sigmoid cancer.
结肠癌手术中肠系膜切除的最佳范围仍不明确。本研究旨在评估在乙状结肠癌根治性切除术中，根据中央血管结扎的高度对围手术期发病率和肿瘤学结果的影响。
在瑞典结直肠癌登记处中确定了所有 I-III 期乙状结肠癌症病例，这些病例均接受了局部根治性切除术（2007-2009 年），并根据血管结扎的位置进行分类，即结扎肠系膜下动脉、结扎直肠上动脉或结扎乙状结肠分支。
共确定了 999 例可进行分类的病例。虽然较高的结扎水平产生了更多的淋巴结，但 3 年或 5 年总生存率、5 年无病生存率或复发率在各组之间没有差异（p=0.79，p=0.41，p=0.67，p=0.51）。在调整了年龄、性别、T 分期、N 分期、美国麻醉医师协会分类和辅助治疗后进行多变量分析，未发现生存差异。
这项大型基于人群的研究表明，在乙状结肠癌切除术中高位结扎可增加淋巴结的检出量，但无生存获益或降低复发率。
