Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Capio St Göran Hospital, Stockholm, Sweden.
Colorectal Dis. 2021 Jun;23(6):1404-1413. doi: 10.1111/codi.15601. Epub 2021 Mar 12.
Complete mesocolic excision (CME) has been proposed as the preferred surgical technique for resection of colon cancer. This prospective cohort study evaluates the effect of CME surgery on colon cancer mortality after right-sided hemicolectomy on a population level.
Data from the Swedish Colorectal Cancer Registry and the Cause of Death Registry on all patients treated with elective right-sided hemicolectomy for colon cancer Stages I-III in the Stockholm County 2008-2012 were analysed. Adherence to principles of CME surgery was determined by structured analysis of anonymized surgical reports regarding the presence of five essential features. The exposure to CME was graded as group 0 (not exposed to CME), group 1 (intermediate) and group 2 (exposed to CME).
In total, 1171 patients were analysed with 234 (20.0%) patients in CME group 0, 453 (38.7%) patients in CME group 1 and 484 (41.3%) in CME group 2. The 5-year colon cancer mortality was 20.2% in CME group 0, 13.9% in CME group 1 and 13.1% in CME group 2 (P = 0.026). The adjusted hazard ratio for colon cancer mortality was 0.61 (95% CI 0.42-0.91; P = 0.014) for CME group 1 and 0.52 (95% CI 0.35-0.77; P = 0.001) for CME group 2.
The presence of predefined CME features in surgical reports was related to a graded benefit on cancer-specific mortality after right-sided hemicolectomy for colon cancer Stages I-III.
完整结肠系膜切除术（CME）已被提议作为结肠癌切除术的首选手术技术。本前瞻性队列研究评估了 CME 手术对斯德哥尔摩县 2008-2012 年接受择期右半结肠切除术治疗的 I-III 期结肠癌患者的结肠癌死亡率的影响。
对所有在斯德哥尔摩县接受择期右半结肠切除术治疗的 I-III 期结肠癌患者的瑞典结直肠癌登记处和死因登记处的数据进行分析。通过对匿名手术报告进行结构分析，确定 CME 手术原则的遵循情况，评估 5 个基本特征的存在情况。暴露于 CME 被分为 0 组（未暴露于 CME）、1 组（中等）和 2 组（暴露于 CME）。
共分析了 1171 例患者，其中 CME 组 0 有 234 例（20.0%），CME 组 1 有 453 例（38.7%），CME 组 2 有 484 例（41.3%）。CME 组 0、CME 组 1 和 CME 组 2 的 5 年结肠癌死亡率分别为 20.2%、13.9%和 13.1%（P=0.026）。CME 组 1 和 CME 组 2 的结肠癌死亡率调整后的危险比分别为 0.61（95%CI 0.42-0.91；P=0.014）和 0.52（95%CI 0.35-0.77；P=0.001）。
手术报告中存在预先定义的 CME 特征与 I-III 期结肠癌右半结肠切除术后癌症特异性死亡率的分级获益相关。
