Magistro Carmelo, Bertoglio Camillo Leonardo, Giani Alessandro, Mazzola Michele, Rubicondo Carolina, Maspero Marianna, Carnevali Pietro, Origi Matteo, Ferrari Giovanni
Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
Surg Endosc. 2022 May;36(5):3049-3058. doi: 10.1007/s00464-021-08601-z. Epub 2021 Jun 15.
Complete mesocolic excision (CME) for right-sided colon cancer (RCC) is a demanding operation, especially when performed laparoscopically. The potential impact of CME in increasing postoperative complications is still unclear. The aim of our study was to evaluate the safety and feasibility of laparoscopic CME compared with laparoscopic non-complete mesocolic excision (NCME) during colectomy for RCC.
Data from a prospectively collected database of patients who underwent laparoscopic right and extended right colectomy at our institution between January 2008 and February 2020 were retrieved and analyzed. Short-term outcomes of patients undergoing CME and NCME were compared. A 1:1 propensity score matching (PSM) was used to balance baseline characteristics between groups.
A total of 663 consecutive patients underwent resection of RCC in the study period. Among these, 500 met the inclusion criteria and after PSM a total of 372 patients were correctly matched, 186 in each group. A similar rate of overall postoperative complications was found between the CME and NCME groups (21.5% and 18.3%, p = 0.436). No difference was found in terms of conversion rate, severe complications, reoperations, readmissions, and mortality. The median number of harvested lymph nodes was higher in the CME group (22 versus 19, p = 0.003), with a lower rate of inadequate sampling (7.0% and 15.1%, p = 0.013).
Laparoscopic CME for RCC is technically feasible and safe. It does not seem to be associated with a higher rate of complications or mortality compared with the "traditional" approach, but it allows better nodal sampling.
右侧结肠癌（RCC）的完整结肠系膜切除术（CME）是一项要求较高的手术，尤其是在腹腔镜下进行时。CME对增加术后并发症的潜在影响仍不清楚。我们研究的目的是评估在RCC结肠切除术期间，腹腔镜CME与腹腔镜非完整结肠系膜切除术（NCME）相比的安全性和可行性。
检索并分析了2008年1月至2020年2月期间在我们机构接受腹腔镜右半结肠和扩大右半结肠切除术患者的前瞻性收集数据库中的数据。比较了接受CME和NCME患者的短期结局。采用1:1倾向评分匹配（PSM）来平衡组间的基线特征。
在研究期间，共有663例连续患者接受了RCC切除术。其中，500例符合纳入标准，经过PSM后，共有372例患者正确匹配，每组186例。CME组和NCME组的总体术后并发症发生率相似（分别为21.5%和18.3%，p = 0.436）。在转化率、严重并发症、再次手术、再次入院和死亡率方面未发现差异。CME组的中位淋巴结清扫数量更高（分别为22个和19个，p = 0.003），采样不足率更低（分别为7.0%和15.1%，p = 0.013）。
腹腔镜CME治疗RCC在技术上是可行且安全的。与“传统”方法相比，它似乎不会导致更高的并发症发生率或死亡率，但能实现更好的淋巴结采样。
