Department of Gastrointestinal Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Av, Wuhan, 430030, People's Republic of China.
Surg Endosc. 2023 Aug;37(8):6107-6117. doi: 10.1007/s00464-023-10095-w. Epub 2023 May 3.
Complete mesocolic excision (CME) or D3 lymphadenectomy led to survival benefits for locally advanced right colon cancer, but with vague definitions in anatomy and debated surgical hazard in clinic. Aiming to achieve a precise definition of it in anatomy, we proposed laparoscopic right hemicolectomy (D3 + CME) as a novel procedure for colon cancer. However, the surgical and oncological results of this procedure in clinic were uncertain.
We performed a cohort study involving prospective data collected from a single-center in China. Data from all patients who underwent right hemicolectomy between January 2014 and December 2018 were included. We compared the surgical and oncological outcomes between D3 + CME and conventional CME.
After implementation of exclusion criteria, a total of 442 patients were included. D3 + CME group performed better in lymph nodes harvested (25.0 [17.0, 33.8] vs. 18.0 [14.0, 25.0], P < 0.001) and the proportion of intraoperative blood loss ≥ 50 mL (31.7% vs. 51.8%, P < 0.001); no significant difference was observed in the complication rates between two groups. Kaplan-Meier analysis demonstrated that a better cumulative 5-year disease-free survival (91.3% vs. 82.2%, P = 0.026) and a better cumulative 5-year overall survival (95.2% vs. 86.1%, P = 0.012) were obtained in the D3 + CME group. Multivariate COX regression revealed that D3 + CME was an independent protective factor for disease-free survival (P = 0.026).
D3 + CME could improve surgical and oncological outcomes simultaneously for right colon cancer compared to conventional CME. Large-scale randomized controlled trials were further required to confirm this conclusion, if possible.
完整结肠系膜切除术（CME）或 D3 淋巴结清扫术为局部晚期右结肠癌带来了生存获益，但在解剖学上定义模糊，临床上存在手术风险争议。为了在解剖学上实现对其的精确定义，我们提出了腹腔镜右半结肠切除术（D3+CME）作为一种新的结肠癌手术方法。然而，该手术在临床上的手术和肿瘤学结果尚不确定。
我们进行了一项队列研究，纳入了来自中国单中心的前瞻性数据。纳入 2014 年 1 月至 2018 年 12 月期间接受右半结肠切除术的所有患者的数据。我们比较了 D3+CME 与传统 CME 的手术和肿瘤学结果。
实施排除标准后，共纳入 442 例患者。D3+CME 组的淋巴结清扫数（25.0[17.0，33.8]比 18.0[14.0，25.0]，P<0.001）和术中出血量≥50 mL 的比例（31.7%比 51.8%，P<0.001）更好；两组的并发症发生率无显著差异。Kaplan-Meier 分析显示，D3+CME 组的累积 5 年无病生存率（91.3%比 82.2%，P=0.026）和累积 5 年总生存率（95.2%比 86.1%，P=0.012）更好。多变量 COX 回归显示，D3+CME 是无病生存率的独立保护因素（P=0.026）。
与传统 CME 相比，D3+CME 可同时改善右结肠癌的手术和肿瘤学结果。如果可能的话，需要进一步进行大规模的随机对照试验来证实这一结论。
