Colorectal Surgery Unit, Department of General and Digestive Surgery, University Hospital of Girona; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
Colorectal Surgery Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
Ann Surg. 2022 Feb 1;275(2):271-280. doi: 10.1097/SLA.0000000000005161.
The aim of this study was to evaluate whether extended complete mesocolic excision (e-CME) for sigmoid colon cancer improves oncological outcomes without compromising morbidity or functional results.
In surgery for cancer of the sigmoid colon and upper rectum, s-CME removes the lymphofatty tissue surrounding the inferior mesenteric artery (IMA), but not the lymphofatty tissue surrounding the portion of the inferior mesenteric vein that does not run parallel to the IMA. Evidence about the safety and efficacy of extending CME to include this tissue is lacking.
This single-blind study randomized sigmoid cancer patients at 4 centers to undergo e-CME or s-CME. The primary outcome was the total number of lymph nodes harvested. Secondary outcomes included disease-free and overall survival at 2 years, morbidity, and bowel and genitourinary function. Clinicaltrials.gov: NCT03107650.
We analyzed 93 patients (46 e-CME and 47 s-CME). Perioperative outcomes were similar between groups. No differences between groups were found in the total number of lymph nodes harvested [21 (interquartile range, IQR, 14-29) in e-CME vs 20 (IQR, 15-27) in s-CME, P = 0.873], morbidity (P = 0.829), disease-free survival (P = 0.926), or overall survival (P = 0.564). The extended specimen yielded a median of 1 lymph node (range, 0-6), none of which were positive.Bowel function recovery was similar between arms at all timepoints. Males undergoing e-CME had worse recovery of urinary function (P = 0.026).
Extending lymphadenectomy to include the IMV territory did not increase the number of lymph nodes or improve local recurrence or survival rates.
本研究旨在评估乙状结肠癌的完全结肠系膜切除术（e-CME）是否能改善肿瘤学结果，而不影响发病率或功能结果。
在乙状结肠和直肠上段癌的手术中，s-CME 切除了肠系膜下动脉（IMA）周围的淋巴脂肪组织，但没有切除不与 IMA 平行的肠系膜下静脉的淋巴脂肪组织。关于将 CME 扩展到包括该组织的安全性和有效性的证据尚缺乏。
这项单盲研究在 4 个中心将乙状结肠癌患者随机分为 e-CME 或 s-CME 组。主要结局是采集的淋巴结总数。次要结局包括 2 年时的无病生存率和总生存率、发病率以及肠和泌尿生殖功能。Clinicaltrials.gov：NCT03107650。
我们分析了 93 例患者（46 例 e-CME 和 47 例 s-CME）。两组患者的围手术期结局相似。两组之间在采集的淋巴结总数[e-CME 为 21（四分位距，IQR，14-29），s-CME 为 20（IQR，15-27），P = 0.873]、发病率（P = 0.829）、无病生存率（P = 0.926）或总生存率（P = 0.564）方面均无差异。扩展标本中位数获得 1 个淋巴结（范围，0-6），均无阳性淋巴结。两组在所有时间点的肠功能恢复情况相似。接受 e-CME 的男性泌尿功能恢复较差（P = 0.026）。
将淋巴结切除术扩展到包括 IMV 区域不会增加淋巴结数量或提高局部复发率或生存率。
