Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850, Lahti, Finland.
Tampere University, Tampere, Finland.
J Gastrointest Surg. 2021 Feb;25(2):475-483. doi: 10.1007/s11605-019-04502-8. Epub 2020 Feb 5.
To compare laparoscopic non-CME colectomy with laparoscopic CME colectomy in two hospitals with similar experience in laparoscopic colorectal surgery.
Data was collected retrospectively from Päijät-Häme Central Hospital (PHCH, NCME group) and Central Finland Central Hospital (CFCH, CME group) records. Elective laparoscopic resections performed during 2007-2016 for UICC stage I-III adenocarcinoma were included to assess differences in short-term outcome and survival.
There were 340 patients in the NCME group and 325 patients in the CME group. CME delivered longer specimens (p < 0.001), wider resection margins (p < 0.001), and more lymph nodes (p < 0.001) but did not result in better 5-year overall or cancer-specific survival (NCME 77.9% vs CME 72.9%, p = 0.528, NCME 93.2% vs CME 88.9%, p = 0.132, respectively). Thirty-day morbidity, mortality, and length of hospital stay were similar between the groups. Conversion to open surgery was associated with decreased survival.
Complete mesocolic excision (CME) is reported to improve survival. Most previous studies have compared open CME with open non-CME (NCME) or open CME with laparoscopic CME. NCME populations have been historical or heterogeneous, potentially causing bias in the interpretation of results. Studies comparing laparoscopic CME with laparoscopic NCME are few and involve only small numbers of patients. In this study, diligently performed laparoscopic non-CME D2 resection delivered disease-free survival results comparable with laparoscopic CME but was not safer.
比较两家具有相似腹腔镜结直肠手术经验的医院的腹腔镜非 CME 结肠切除术与腹腔镜 CME 结肠切除术。
从皮耶塔-海梅中央医院（PHCH，NCME 组）和中芬兰中央医院（CFCH，CME 组）的记录中收集数据。纳入 2007-2016 年间因 UICC 分期 I-III 期腺癌行择期腹腔镜切除术的患者，以评估短期结果和生存差异。
NCME 组有 340 例患者，CME 组有 325 例患者。CME 提供了更长的标本（p<0.001）、更宽的切除边缘（p<0.001）和更多的淋巴结（p<0.001），但没有带来更好的 5 年总生存率或癌症特异性生存率（NCME 为 77.9% vs CME 为 72.9%，p=0.528，NCME 为 93.2% vs CME 为 88.9%，p=0.132）。两组的 30 天发病率、死亡率和住院时间相似。转为开放手术与生存率降低相关。
完全结肠系膜切除术（CME）被报道可改善生存率。大多数先前的研究比较了开腹 CME 与开腹非 CME（NCME）或开腹 CME 与腹腔镜 CME。NCME 人群为历史或异质人群，可能会对结果的解释产生偏差。比较腹腔镜 CME 与腹腔镜 NCME 的研究很少，且仅涉及少量患者。在这项研究中，精心实施的腹腔镜非 CME D2 切除术带来了与腹腔镜 CME 相当的无病生存率结果，但安全性没有提高。
