You X L, Lian Y J, Wu J, Wang Y J, Dai J W, Zhao X J, Cheng Z Y, Huang C J, Li W Q, Zhou Y
Department of Gastrointestinal Surgery, Taizhou People's Hospital, Taizhou, Jiangsu 225300, China.
Department of Medical Quality and Safety Control, Taizhou People's Hospital, Taizhou, Jiangsu 225300, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Dec 25;23(12):1164-1169. doi: 10.3760/cma.j.cn.441530-20200128-00035.
The operative approach and steps of laparoscopic right hemicolon cancer radical resection have been standardlized and professional consensus has been reached. However, some detailed issues such as the handling of Henle's trunk and whether to preserve the right gastroepiploic vein (RGEV) still remain controversial. This study investigates the safety, feasibility, short- and long-term outcomes of preserving RGEV during laparoscopic right hemicolectomy. A retrospective cohort study was carried out. Clinical data of 92 patients undergoing laparoscopic right hemicolectomy in Taizhou People's Hospital from March 2016 to May 2018 were retrospectively analyzed. All the patients were treated with complete mesocolon resection (CME) and had complete postoperative pathological data and follow-up data. Based on the tumor location, 49 patients preserved RGEV (preservation group) and 43 did not (non-preservation group). Pathological data, postoperative complications, short- and long-term outcomes were compared between the two groups. There were no significant differences in baseline data between the two groups (all >0.05). No significant differences were found in operation time, intraoperative blood loss, unplanned reoperation, anastomotic leak, number of harvested lymph nodes, number of metastatic lymph node, and time to food intake after surgery between two groups (all >0.05). Compared with non-preservation group, the preservation group had faster recovery of anal gas passage after operation [(3.1±1.0) days vs. (4.0±1.7) days, =-2.787, =0.007], shorter length of hospitalization [(11.5±1.5) days vs. (15.0±7.9) days, =-2.823, =0.007], and reduced the hospitalization expenses [(46 000±5000) yuan to (57 000±33 000) yuan, =-2.076, =0.044]. No postoperative gastroparesis (PGS) occurred in the preservation group, while 6 cases in the non-preservation group developed gastroparesis during perioperative period (<0.05). The median time of follow-up time was 31.8 (5.2-43.7) months. The overall survival time of the preservation group and non-preservation group was (35.4±1.8) months and (37.6±1.7) months, respectively without significant difference (=0.336); the disease-free survival was (32.0±2.2) months and (35.5±2.0) months, respectively without significant difference as well (=0.201). Dissection of the Henle's truck and preservation of RGEV is safe and feasible during laparoscopic right hemicolectomy, which can significantly reduce the incidence of postoperative gastroparesis, shorten the recovery time of postoperative intestinal function and hospitalization, and decrease the cost of hospitalization. The efficacy of RGEV preservation is similar to non-preservation of RGEV.
腹腔镜右半结肠癌根治术的手术入路及步骤已规范化并达成专业共识。然而，一些细节问题，如处理Henle干以及是否保留胃网膜右静脉（RGEV）仍存在争议。本研究探讨在腹腔镜右半结肠切除术中保留RGEV的安全性、可行性、短期和长期结局。进行了一项回顾性队列研究。回顾性分析了2016年3月至2018年5月在泰州市人民医院接受腹腔镜右半结肠切除术的92例患者的临床资料。所有患者均接受完整结肠系膜切除术（CME），并具有完整的术后病理数据和随访数据。根据肿瘤位置，49例患者保留RGEV（保留组），43例未保留（非保留组）。比较两组的病理数据、术后并发症、短期和长期结局。两组基线数据无显著差异（均>0.05）。两组在手术时间、术中出血量、非计划性再次手术、吻合口漏、清扫淋巴结数目、转移淋巴结数目及术后进食时间方面均无显著差异（均>0.05）。与非保留组相比，保留组术后肛门排气恢复更快[（3.1±1.0）天对（4.0±1.7）天，=-2.787，=0.007]，住院时间更短[（11.5±1.5）天对（15.0±7.9）天，=-2.823，=0.007]，住院费用降低[（46 000±5000）元至（57 000±33 000）元，=-2.076，=0.044]。保留组未发生术后胃瘫（PGS），而非保留组有6例患者在围手术期发生胃瘫（<0.05）。中位随访时间为31.8（5.2 - 43.7）个月。保留组和非保留组的总生存时间分别为（35.4±1.8）个月和（37.6±1.7）个月，无显著差异（=0.336）；无病生存时间分别为（32.0±2.2）个月和（35.5±2.0）个月，也无显著差异（=0.201）。在腹腔镜右半结肠切除术中，解剖Henle干并保留RGEV是安全可行的，可显著降低术后胃瘫的发生率，缩短术后肠道功能恢复时间和住院时间，并降低住院费用。保留RGEV的疗效与不保留RGEV相似。
