Puckett Yana, Mitchell Diana, Pham Theophilus
Department of General Surgery, Texas Tech University Health Sciences Center, Lubboc, TX 79430, USA.
Ecancermedicalscience. 2019 Oct 14;13:968. doi: 10.3332/ecancer.2019.968. eCollection 2019.
Colorectal cancer is the third most commonly diagnosed cancer worldwide. Lymph node (LN) retrieval is a key factor for pathologic staging and prognosis of colorectal cancer. Increase in number of LNs removal suggests improvement in tumour clearance and decrease in metastatic spread. Studies have suggested that excising 12 or more LNs during colectomy in patients with colon cancer is associated with improved survival. To date, there have been no studies to determine whether minimally invasive surgery affects the ability to retrieve 12+ LNs in elective colon cancer surgery. Therefore, we elected to determine whether a difference exists on the ability to retrieve 12+ nodes in elective colon cancer colectomies performed open versus laparoscopic.
The National Surgical Quality Improvement Program (NSQIP) Procedure Specific Colectomy database was analysed for the year 2014-2015. Inclusion criteria were colon cancer (ICD-9 Code 153.9), age greater than 18 years. Exclusion criteria were missing data. Data abstracted included patient demographics, type of operation performed and number of LNs retrieved. The patients were categorised based on their elective colon cancer colectomies such as laparoscopic or open. Binary logistic regression was used to identify confounding variables in the retrieval of 12+ LNs.
After accounting for missing cases, a total of 18,792 patients with a diagnosis of colon cancer were analysed. Twelve or more LNs were retrieved in 88% (16,538) of patients, Among them, 2,516 patients underwent laparoscopic colectomy and 5,284 patients underwent open colectomy. The difference was not statistically significant for the average number of LNs retrieved among both the groups. Open operative approach compared to the laparoscopic approach was associated with 15% greater odds of retrieval of >12 LNs (OR 1.148; 95% CI (1.035-1.272); = 0.008).
The majority of colectomies such as open or laparoscopic are able to retrieve 12 or more LNs. However, there are greater odds of retrieving more than 12 LNs with the open approach compared to the laparoscopic approach. By allowing for more LN retrieval, open colectomies suggest improvement in tumour clearance and decrease metastatic spread. Additional research is needed to further investigate the specific factors influencing the ability to retrieve an adequate number of LNs, such as viewing angles provided with an open approach versus laparoscopic approach.
结直肠癌是全球第三大常见诊断癌症。淋巴结（LN）清扫是结直肠癌病理分期和预后的关键因素。切除的淋巴结数量增加表明肿瘤清除效果改善且转移扩散减少。研究表明，结肠癌患者在结肠切除术中切除12个或更多淋巴结与生存率提高相关。迄今为止，尚无研究确定微创手术是否会影响择期结肠癌手术中清扫12个及以上淋巴结的能力。因此，我们选择确定在择期结肠癌结肠切除术中行开放手术与腹腔镜手术在清扫12个及以上淋巴结的能力上是否存在差异。
分析2014 - 2015年国家外科质量改进计划（NSQIP）特定手术结肠切除术数据库。纳入标准为结肠癌（ICD - 9编码153.9）、年龄大于18岁。排除标准为数据缺失。提取的数据包括患者人口统计学信息、所行手术类型及清扫的淋巴结数量。患者根据择期结肠癌结肠切除术类型分为腹腔镜手术或开放手术。采用二元逻辑回归确定清扫12个及以上淋巴结时的混杂变量。
在排除缺失病例后，共分析了18792例诊断为结肠癌的患者。88%（16538例）的患者清扫了12个或更多淋巴结，其中2516例患者接受了腹腔镜结肠切除术，5284例患者接受了开放结肠切除术。两组清扫的淋巴结平均数量差异无统计学意义。与腹腔镜手术入路相比，开放手术入路清扫>12个淋巴结的几率高15%（比值比1.148；95%置信区间（1.035 - 1.272）；P = 0.008）。
大多数结肠切除术，如开放手术或腹腔镜手术，都能够清扫12个或更多淋巴结。然而，与腹腔镜手术入路相比，开放手术入路清扫超过12个淋巴结的几率更高。通过允许清扫更多淋巴结，开放结肠切除术表明肿瘤清除效果改善且转移扩散减少。需要进一步研究以深入探究影响清扫足够数量淋巴结能力的具体因素，如开放手术入路与腹腔镜手术入路的视角。
