右半结肠切除术在低级别阑尾黏液性腺癌患者中的作用。
Role of right hemicolectomy in patients with low-grade appendiceal mucinous adenocarcinoma.
机构信息
Surgery Group of Los Angeles, 8635 West 3rd Street Suite 880, Los Angeles, CA, 90048, USA; Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
Surgery Group of Los Angeles, 8635 West 3rd Street Suite 880, Los Angeles, CA, 90048, USA; Cedars Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA, 90048, USA.
出版信息
Am J Surg. 2019 Dec;218(6):1239-1243. doi: 10.1016/j.amjsurg.2019.07.035. Epub 2019 Jul 25.
BACKGROUND
There is little consensus with regards to the most appropriate surgical management for low-grade appendiceal mucinous adenocarcinomas (LAMA), though right hemicolectomy is usually recommended.
METHODS
The SEER database was queried for all patients with non-metastatic LAMA. Disease specific and overall survival was compared by surgery type: 1) appendectomy, 2) formal right hemicolectomy 3) non-formal colectomy (including ileocecectomy).
RESULTS
A total of 579 patients with non-metastatic LAMA were identified. 133 (23%), 404 (70%), and 42 (7%) of patients had stage I, II, and III disease, respectively. 99 (17.1%) had appendectomy, 87 (15%) had non-formal colectomy, and 302 (52.2%) had formal right hemicolectomy. We observed no significant differences in disease specific or overall survival by surgery type. Controlling for age and stage, surgery type was not a significant predictor of disease specific or overall survival.
CONCLUSION
In patients with localized LAMA, right hemicolectomy did not increase disease specific or overall survival. Right hemicolectomy should be reserved for LAMA patients with positive margins post appendectomy.
背景
对于低级别阑尾黏液性腺癌（LAMA），目前对于最合适的手术治疗方法尚未达成共识，尽管通常建议进行右半结肠切除术。
方法
在 SEER 数据库中检索所有非转移性 LAMA 患者。通过手术类型比较疾病特异性和总生存率：1）阑尾切除术，2）正式右半结肠切除术，3）非正规结肠切除术（包括回盲部切除术）。
结果
共确定了 579 例非转移性 LAMA 患者。分别有 133 例（23%）、404 例（70%）和 42 例（7%）患者处于 I 期、II 期和 III 期。99 例（17.1%）患者行阑尾切除术，87 例（15%）患者行非正规结肠切除术，302 例（52.2%）患者行正式右半结肠切除术。我们没有观察到手术类型与疾病特异性或总生存率之间的显著差异。控制年龄和分期后，手术类型不是疾病特异性或总生存率的显著预测因素。
结论
在局限性 LAMA 患者中，右半结肠切除术并未增加疾病特异性或总生存率。对于阑尾切除术后切缘阳性的 LAMA 患者，应保留右半结肠切除术。
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