回肠末端或盲肠神经内分泌肿瘤的外科治疗：回盲部切除术与右半结肠切除术

Surgical Treatment of Neuroendocrine Tumors of the Terminal Ileum or Cecum: Ileocecectomy Versus Right Hemicolectomy.

作者信息

Li Mu-Xing, Lopez-Aguiar Alexandra G, Poultsides George, Rocha Flavio, Weber Sharon, Fields Ryan, Idrees Kamran, Cho Cliff, Maithel Shishir K, Zhang Xu-Feng, Pawlik Timothy M

机构信息

Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, China.

Department of General Surgery, Peking University Third Hospital, Beijing, China.

出版信息

J Gastrointest Surg. 2022 Jun;26(6):1266-1274. doi: 10.1007/s11605-022-05269-1. Epub 2022 Feb 11.

DOI:10.1007/s11605-022-05269-1

PMID:35149952

Abstract

BACKGROUND

Simple ileocecectomy and right hemicolectomy are two potential operative approaches to treat patients with neuroendocrine neoplasm in the terminal ileum and/or cecum (IC-NENs). We sought to define the long-term outcome of patients undergoing ileocecectomy versus right hemicolectomy for IC-NENs, as well as characterize number of nodes evaluated and lymph node metastasis (LNM) associated with each procedure.

METHODS

Patients who underwent curative-intent resections for IC-NENs between 2000 and 2016 were identified from a multi-institutional database. The clinicopathologic characteristics, surgical procedures, and the overall (OS) and recurrence-free survival (RFS) were compared among patients who underwent formal right hemicolectomy versus ileocecectomy only.

RESULTS

Among 127 patients with IC-NENs, median size of the largest tumor size was 2.0 (IQR 1.2-2.9) cm; 35 (27.6%) patients had multiple lesions. At the time of surgery, 93 (73.2%) patients underwent a right hemicolectomy, whereas 34 (26.8%) had ileocecectomy only. Every patient had a lymph node dissection (LND) with a median number of 16 (IQR 12-22) nodes evaluated. A majority (n = 110, 86.6%) of patients had LNM with a median number of 3 (IQR 2-5) LNM. Patients who underwent hemicolectomy had more lymph nodes evaluated versus patients who had an ileocecectomy only (median, 18 vs. 14, p = 0.004). Patients who underwent formal right hemicolectomy versus ileocecectomy had a similar OS (median OS, 101.9 vs. 144.5 months, p = 0.44) and RFS (median RFS, 70.3 vs. not attained, p = 0.80), respectively.

CONCLUSIONS

Ileocecectomy had similar long-term outcomes versus right hemicolectomy in treatment of IC-NENs despite a difference in the lymph node harvest.

摘要

背景

单纯回盲部切除术和右半结肠切除术是治疗回肠末端和/或盲肠神经内分泌肿瘤（IC-NENs）患者的两种潜在手术方式。我们试图确定接受回盲部切除术与右半结肠切除术治疗IC-NENs患者的长期结局，并描述每种手术评估的淋巴结数量及淋巴结转移（LNM）情况。

方法

从一个多机构数据库中识别出2000年至2016年间接受IC-NENs根治性切除术的患者。比较接受正规右半结肠切除术与仅接受回盲部切除术患者的临床病理特征、手术方式以及总生存期（OS）和无复发生存期（RFS）。

结果

在127例IC-NENs患者中，最大肿瘤大小的中位数为2.0（四分位间距1.2 - 2.9）cm；35例（27.6%）患者有多个病灶。手术时，93例（73.2%）患者接受了右半结肠切除术，而34例（26.8%）仅接受了回盲部切除术。每位患者均进行了淋巴结清扫（LND），评估的淋巴结数量中位数为16（四分位间距12 - 22）个。大多数（n = 110，86.6%）患者有LNM，LNM数量中位数为3（四分位间距2 - 5）个。接受半结肠切除术的患者与仅接受回盲部切除术的患者相比，评估的淋巴结更多（中位数，18个对14个，p = 0.004）。接受正规右半结肠切除术与回盲部切除术的患者分别有相似的OS（中位OS，101.9个月对144.5个月，p = 0.44）和RFS（中位RFS，70.3个月对未达到，p = 0.80）。