Department of Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India.
Colorectal Dis. 2024 Jan;26(1):63-72. doi: 10.1111/codi.16815. Epub 2023 Nov 28.
Although complete mesocolic excision (CME) for colon cancer is oncologically sound, to date, there has been no consensus on the extent of lymphadenectomy in radical right colectomy. This study essentially compared the perioperative and survival outcomes of CME with two templates of lymphadenectomy for right colon cancer.
This was a propensity matched, retrospective analysis of a single centre, prospectively maintained database of all patients undergoing elective right colectomy for nonmetastatic, biopsy-proven adenocarcinoma from November 2013 to October 2018. CME + D3 was adopted selectively, documented prospectively, and compared with patients undergoing CME + central vascular ligation (CVL). The only technical difference between the groups was the excision of the surgical trunk of Gillot in the CME + D3 group. Postoperative, long-term outcomes and patterns of recurrence were compared between the groups.
Of the 244 eligible patients, 88 (36.1%) and 156 (63.9%) underwent CME + D3 and CME + CVL, respectively. Matched groups (72 [CME + D3] vs. 108 [CME + CVL]) showed no difference in histology, tumour grade, postoperative complications, mortality, and hospital stay. CME + D3 was preferentially performed laparoscopically (35.2% vs. 9%), was associated with lower blood loss (215 mL vs. 297 mL, p = 0.001), higher nodal yield (31 vs. 25 nodes, p = 0.003) and a higher incidence of chyle leak (4 vs. 0, p = 0.013). At a median follow-up of more than 57 months, there was no significant difference in local recurrence, disease-free or overall survival.
In this retrospective study, lymphadenectomy along the superior mesenteric vein, as a component of CME for right colon cancer, offered a higher nodal yield with no improvement in oncological outcome. Dissection of the SMV, over and above a D2 dissection, could therefore be restricted to specialized colorectal units until further studies establish the incremental oncological benefit of this extended lymphadenectomy or define a patient group in whom it is beneficial.
虽然完整结肠系膜切除术（CME）在肿瘤学上是合理的，但迄今为止，对于根治性右半结肠切除术的淋巴结清扫范围尚无共识。本研究主要比较了 CME 联合两种右半结肠癌淋巴结清扫模板的围手术期和生存结果。
这是一项单中心、前瞻性维护数据库的倾向匹配回顾性分析，纳入 2013 年 11 月至 2018 年 10 月期间所有接受非转移性、经活检证实的右半结肠癌择期右半结肠切除术的患者。选择性采用 CME+D3，并进行前瞻性记录，与接受 CME+中央血管结扎术（CVL）的患者进行比较。两组之间唯一的技术差异是在 CME+D3 组中切除 Gillot 的手术干。比较两组之间的术后长期结局和复发模式。
在 244 名符合条件的患者中，88 名（36.1%）和 156 名（63.9%）分别接受了 CME+D3 和 CME+CVL。匹配组（72 名 CME+D3 组与 108 名 CME+CVL 组）在组织学、肿瘤分级、术后并发症、死亡率和住院时间方面无差异。CME+D3 组更倾向于腹腔镜手术（35.2% vs. 9%），术中出血量更少（215ml vs. 297ml，p=0.001），淋巴结检出数更多（31 枚 vs. 25 枚，p=0.003），乳糜漏发生率更高（4 例 vs. 0 例，p=0.013）。中位随访时间超过 57 个月，局部复发、无病生存或总体生存无显著差异。
在这项回顾性研究中，作为右半结肠癌 CME 的一部分，沿肠系膜上静脉进行淋巴结清扫提供了更高的淋巴结检出率，但在肿瘤学结果方面没有改善。因此，超过 D2 清扫的 SMV 解剖可以仅限于专门的结直肠单位，直到进一步的研究确定这种扩展淋巴结清扫的增量肿瘤学获益或定义受益的患者群体。
