The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, Guangdong Province, China.
Department of Gastrointestinal Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Shunde, Foshan, 528300, Guangdong Province, China.
Updates Surg. 2023 Aug;75(5):1149-1160. doi: 10.1007/s13304-023-01514-7. Epub 2023 May 13.
The purpose of this study was to compare the "caudal to cranial" (CC) versus "medial to lateral" (ML) approach for laparoscopic right hemicolectomy. Pertinent data from all patients with stage II and III between January 2015 and August 2017 were entered into a retrospective database. A total of 175 patients underwent the ML (N = 109) or CC approach (N = 66). Patient characteristics were equivalent between groups. The CC group showed a shorter surgical time 170.00 (145.00, 210.00) vs. (206.50 (178.75, 226.25) min) than the ML group (p < 0.001). The time to oral intake was shorter in the CC group than in the ML group ((3.00 (1.00, 4.00) vs. 3.00 (2.00, 5.00) days; p = 0.007). For the total harvested lymph nodes, there was no statistical significance between the CC group 16.50 (14.00, 21.25) and the ML group 18.00 (15.00, 22.00) (p = 0.327), and no difference was found in the positive harvested lymph nodes (0 (0, 2.00) vs. 0 (0, 1.50); p = 0.753). Meanwhile, no differences were found in other perioperative or pathological outcomes, including blood loss and complications. For 5-year prognosis, overall survival rates were 75.76% in the CC group and 82.57% in the ML group (HR 0.654, 95% CI 0.336-1.273, p = 0.207); disease-free survival rates were 80.30% in the CC group and 85.32% in the ML group (HR 0.683, 95% CI 0.328-1.422, p = 0.305). Both approaches were safe and feasible and resulted in excellent survival. The CC approach was beneficial in terms of the surgical time and time to oral intake.
本研究旨在比较腹腔镜右半结肠切除术的“头侧到尾侧”（CC）与“内侧到外侧”（ML）入路。2015 年 1 月至 2017 年 8 月期间所有 II 期和 III 期患者的数据均被录入回顾性数据库。共 175 例患者接受了 ML（N=109）或 CC 入路（N=66）。两组患者的一般特征无差异。CC 组的手术时间更短，为 170.00（145.00，210.00）分钟，而 ML 组为 206.50（178.75，226.25）分钟（p<0.001）。CC 组的首次经口进食时间也短于 ML 组（（3.00（1.00，4.00）vs. 3.00（2.00，5.00）天；p=0.007）。对于总清扫淋巴结数，CC 组为 16.50（14.00，21.25），ML 组为 18.00（15.00，22.00），两组之间无统计学差异（p=0.327），阳性清扫淋巴结数也无差异（0（0，2.00）vs. 0（0，1.50）；p=0.753）。同时，在其他围手术期或病理结果方面，包括出血量和并发症，两组之间也无差异。在 5 年预后方面，CC 组的总生存率为 75.76%，ML 组为 82.57%（HR 0.654，95%CI 0.336-1.273，p=0.207）；CC 组的无病生存率为 80.30%，ML 组为 85.32%（HR 0.683，95%CI 0.328-1.422，p=0.305）。两种方法均安全可行，且生存率极佳。CC 组在手术时间和首次经口进食时间方面具有优势。
