Department of Surgery, Mayo Clinic, Jacksonville, FL, USA.
Division of Colon & Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA.
J Gastrointest Surg. 2020 Jul;24(7):1648-1654. doi: 10.1007/s11605-019-04271-4. Epub 2019 Jul 3.
Controversy exists regarding optimal surgical approach to right-sided colon cancer due to increasing complete mesocolic excision outcome data; yet, scarce long-term surgical and oncologic outcome data from high-volume centers following right segmental resections without complete mesocolic excision make comparisons difficult to interpret. We report long-term outcomes following standard mesocolic excision for right-sided colon adenocarcinoma.
A retrospective review of a prospective database was conducted of all consecutive adult patients undergoing surgery for a right-sided colon adenocarcinoma between 2000 and 2007. Demographics, oncologic, operative, and pathologic details are reported. Primary endpoints consisted of overall survival and recurrence. Patients with stage IV and recurrent disease were excluded.
Eight hundred thirteen patients were identified. Majority of tumors were stage II (n = 318, 39%). Adjuvant chemotherapy was administered to 228 patients (28%). Recurrence was observed in 97 patients (12%), at median 1.3 years. Recurrence was most commonly distant (n = 73, 9%). At median follow-up 7.3 years, 5- and 10-year overall survival was 72.4%, and 48.6%, respectively. Five- and 10-year disease-free survival was 67% and 45.8%, respectively. Multivariable analysis demonstrated that TNM stage was a significant predictor of recurrence. For disease-free survival, T stage, and N stage were significant on multivariate analysis. Multivariable predictors of overall survival included age, number of lymph nodes removed, N stage, and adjuvant chemotherapy use.
Excellent long-term outcomes from a large cohort of patients with non-metastatic, right colon adenocarcinoma treated by segmental colectomy without complete mesocolic excision are reported. The majority of recurrences were distant.
由于完整结肠系膜切除术的结果数据不断增加，右侧结肠癌的最佳手术方法存在争议；然而，在没有完整结肠系膜切除术的情况下，高容量中心进行右节段切除后的长期手术和肿瘤学结果数据很少，使得比较难以解释。我们报告了在右侧结肠癌腺癌中进行标准结肠系膜切除术的长期结果。
对 2000 年至 2007 年间连续接受右侧结肠癌腺癌手术的所有成年患者的前瞻性数据库进行了回顾性分析。报告了人口统计学、肿瘤学、手术和病理细节。主要终点包括总生存和复发。排除了 IV 期和复发性疾病的患者。
共确定了 813 例患者。大多数肿瘤为 II 期（n=318，39%）。228 例患者接受了辅助化疗（28%）。97 例（12%）患者观察到复发，中位时间为 1.3 年。复发最常见的是远处（n=73，9%）。中位随访 7.3 年后，5 年和 10 年总生存率分别为 72.4%和 48.6%。5 年和 10 年无病生存率分别为 67%和 45.8%。多变量分析表明，TNM 分期是复发的显著预测因素。对于无病生存，T 分期和 N 分期在多变量分析中具有显著意义。总生存的多变量预测因素包括年龄、切除的淋巴结数量、N 分期和辅助化疗的使用。
在没有完整结肠系膜切除术的情况下，对非转移性右侧结肠癌进行节段性结肠切除术的大量患者中，报告了优异的长期结果。大多数复发是远处的。
