Li Chen, Wang Quan, Jiang Ke-Wei
Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China.
World J Gastrointest Oncol. 2021 May 15;13(5):391-399. doi: 10.4251/wjgo.v13.i5.391.
Colorectal cancers comprise a large percentage of tumors worldwide, and transverse colon cancer (TCC) is defined as tumors located between hepatic and splenic flexures. Due to the anatomy and embryology complexity, and lack of large randomized controlled trials, it is a challenge to standardize TCC surgery. In this study, the current situation of transverse/extended colectomy, robotic/ laparoscopic/open surgery and complete mesocolic excision (CME) concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap. In summary, transverse colectomy challenges the dogma of traditional extended colectomy, with similar oncological and prognostic outcomes. Compared with conventional open resection, laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy. The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes. According to published studies, laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.
结直肠癌在全球范围内的肿瘤中占很大比例，横结肠癌（TCC）被定义为位于肝曲和脾曲之间的肿瘤。由于解剖学和胚胎学的复杂性，以及缺乏大型随机对照试验，标准化TCC手术具有挑战性。在本研究中，讨论了TCC手术中横结肠/扩大结肠切除术、机器人/腹腔镜/开放手术以及完整结肠系膜切除术（CME）概念的现状，并绘制了热图以显示证据水平和差距。总之，横结肠切除术挑战了传统扩大结肠切除术的教条，其肿瘤学和预后结果相似。与传统开放切除术相比，腹腔镜和机器人手术在横结肠切除术和扩大结肠切除术中都发挥着更重要的作用。CME概念可能有助于TCC的根治性切除和充分的淋巴结清扫。根据已发表的研究，基于CME概念的腹腔镜或机器人横结肠切除术是TCC患者合适的手术方式。
