Department of Colorectal Surgery, Chungnam National University Hospital and College of Medicine, 282 Munwharo Junggu, Daejeon, 35015, Republic of Korea.
Surg Endosc. 2024 Oct;38(10):6037-6045. doi: 10.1007/s00464-024-11159-1. Epub 2024 Aug 12.
Surgical standardization for transverse colon cancers (TCC) has not been established, and the oncologic benefit of central vessel ligation (CVL) are still unclear. This study aimed to evaluate the oncologic safety of TCC surgery without CVL of the middle colic artery (MCA).
This is a single-center, retrospective, observational, comparative study. The clinical, surgical, and pathological characteristics of the patients who underwent radical surgery for non-metastatic TCC between January 2012 and December 2020 were investigated, and the characteristic and oncologic outcomes of No CVL and CVL groups were compared.
The number of No CVL and CVL groups was 47 (44.3%) and 59 (55.7%), respectively. There was no statistically significant difference between the two groups in surgical complications, stage, mean number of retrieved lymph nodes (LN) (24.12 vs. 22.36 p = 0.464), mean number of metastatic LN (1.53 vs. 0.74, p = 0.163), mean proximal margin (19.2 cm vs. 16.7 cm, p = 0.139), mean distal margin (9.6 cm vs. 9.9 cm, p = 0.753), adjuvant chemotherapy, total recurrence rate (6.4 vs. 11.9%, p = 0.507), lymphatic recurrence rate (0.0% vs. 5.1%, p = 0.253), and local recurrence rate (2.1 vs. 1.7%, p = 0.984). Furthermore, there was no statistically significant difference of 5-year disease-free survival (DFS) and overall survival (OS) in stage II (DFS: 94.4 vs. 91.3%, p = 0.685, OS: 94.1 vs. 95.5%, p = 0.838) and stage III (DFS: 88.5 vs. 68.4%, p = 0.253, OS: 100.0% vs. 79.7, p = 0.328).
TCC surgery without CVL of the MCA showed comparable surgical and oncologic outcomes compared to surgery with CVL. Therefore, preservation of a branch of the MCA may be considered a safe option, when combined with adequate lymph node dissection, if necessary. A large, prospective, and controlled study will be necessary to provide solid evidence of the oncologic safety of this procedure.
横结肠癌（TCC）的手术标准化尚未建立，中央血管结扎（CVL）的肿瘤获益仍不清楚。本研究旨在评估不结扎中结肠动脉（MCA）的 TCC 手术的肿瘤安全性。
这是一项单中心、回顾性、观察性、对照研究。调查了 2012 年 1 月至 2020 年 12 月期间接受非转移性 TCC 根治性手术的患者的临床、手术和病理特征，并比较了无 CVL 组和 CVL 组的特征和肿瘤学结果。
无 CVL 组和 CVL 组的数量分别为 47 例（44.3%）和 59 例（55.7%）。两组在手术并发症、分期、平均淋巴结检出数（24.12 比 22.36，p=0.464）、平均转移淋巴结数（1.53 比 0.74，p=0.163）、平均近端切缘（19.2cm 比 16.7cm，p=0.139）、平均远端切缘（9.6cm 比 9.9cm，p=0.753）、辅助化疗、总复发率（6.4%比 11.9%，p=0.507）、淋巴复发率（0.0%比 5.1%，p=0.253）和局部复发率（2.1%比 1.7%，p=0.984）方面均无统计学差异。此外，在 II 期（DFS：94.4%比 91.3%，p=0.685，OS：94.1%比 95.5%，p=0.838）和 III 期（DFS：88.5%比 68.4%，p=0.253，OS：100.0%比 79.7%，p=0.328），两组的 5 年无病生存率（DFS）和总生存率（OS）均无统计学差异。
不结扎 MCA 的 TCC 手术与 CVL 手术相比，具有相似的手术和肿瘤学结果。因此，如果需要，保留 MCA 的分支可能是一种安全的选择，同时要结合充分的淋巴结清扫。需要进行大规模、前瞻性、对照研究，以提供该手术肿瘤安全性的可靠证据。
