Gao F, Han B, Zhang Y H, Zhao H Y, Wang H, Guo M S
Department of General Surgery, the Second Affiliated Hospital, Zhengzhou University, Zhengzhou450014, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2024 Dec 25;27(12):1276-1283. doi: 10.3760/cma.j.cn441530-20240116-00029.
To investigate and compare the clinical efficacy and prognosis of D3 lymphadenectomy/complete mesocolic excision in treatment of right colon cancer with different medial boundaries. We searched The Cochrane Library, Pubmed, Embase, CBM, VIP, CNKI, and WanFang data bases for superior mesenteric artery (SMA)-oriented and superior mesenteric vein (SMV)-oriented D3 lymphadenectomy/complete mesocolic excision from inception to December, 2023. The resultant data were submitted to meta-analysis using RevMan 5.3 software. In total, we identified nine eligible studies involving 2467 patients. The SMA group had 982 patients and the SMV group had 1 485 patients. Meta-analysis revealed no significant differences in intraoperative bleeding volume, postoperative time to passage of flatus, or postoperative drainage volume between the two studied approaches. The durations of surgery and of postoperative hospital stay were both significantly longer in the SMA than SMV group (weighted mean difference [WMD]=17.70, 95%CI: 6.90-28.50, =0.001; WMD=0.40, 95%CI: 0.07-0.72, =0.020, respectively). Furthermore, the rate of postoperative complications was greater in the SMA than SMV group. For example, the incidences of postoperative chyle leakage and diarrhea were significantly higher in the SMA than SMV group, (OR=1.25, 95%CI: 1.01-1.54, = 0.040; OR=3.60, 95%CI: 2.39-5.41, < 0.001; OR=2.13, 95%CI: 1.10-4.11, = 0.020, respectively). In terms of oncological efficacy, the total number of lymph nodes dissected and the number of positive lymph nodes in the SMA group were significantly higher than in the SMV group (WMD=2.76, 95%CI:1.22-4.31, 0.001, WMD=0.59, 95%CI: 0.06-1.12, = 0.030). Laparoscopic surgery for right colon cancer, using the left margin of the SMA as the medial boundary for dissection is associated with a higher risk of postoperative complications, such as chyle leakage and diarrhea, than is using the superior mesenteric vein as the medial boundary. The durations of surgery and postoperative hospital stay are longer. SMA left margin dissection has significant oncological advantages, including a higher total number of harvested lymph nodes and of positive lymph nodes.
探讨并比较以不同内侧边界进行D3淋巴结清扫术/完整结肠系膜切除术治疗右结肠癌的临床疗效及预后。我们检索了Cochrane图书馆、Pubmed、Embase、中国生物医学文献数据库（CBM）、维普资讯（VIP）、中国知网（CNKI）和万方数据库，收集自建库至2023年12月以肠系膜上动脉（SMA）为导向和以肠系膜上静脉（SMV）为导向的D3淋巴结清扫术/完整结肠系膜切除术的相关研究。将所得数据使用RevMan 5.3软件进行荟萃分析。总共，我们纳入了9项符合条件的研究，涉及2467例患者。SMA组有982例患者，SMV组有1485例患者。荟萃分析显示，两种研究方法在术中出血量、术后排气时间或术后引流量方面无显著差异。SMA组的手术时间和术后住院时间均显著长于SMV组（加权均数差[WMD]=17.70，95%置信区间：6.90 - 28.50，P = 0.001；WMD = 0.40，95%置信区间：0.07 - 0.72，P = 0.020）。此外，SMA组的术后并发症发生率高于SMV组。例如，SMA组术后乳糜漏和腹泻的发生率显著高于SMV组（比值比[OR]=1.25，95%置信区间：1.01 - 1.54，P = 0.040；OR = 3.60，95%置信区间：2.39 - 5.41，P < 0.001；OR = 2.13，95%置信区间：1.10 - 4.11，P = 0.020）。在肿瘤学疗效方面，SMA组清扫的淋巴结总数和阳性淋巴结数均显著高于SMV组（WMD = 2.76，95%置信区间：1.22 - 4.31，P = 0.001；WMD = 0.59，95%置信区间：0.06 - 1.12，P = 0.030）。对于右结肠癌的腹腔镜手术，以SMA的左侧缘为内侧边界进行清扫比以肠系膜上静脉为内侧边界术后出现乳糜漏和腹泻等并发症的风险更高。手术时间和术后住院时间更长。以SMA左侧缘进行清扫具有显著的肿瘤学优势，包括收获的淋巴结总数和阳性淋巴结数更多。
