Efetov S K, Tomasicchio G, Kayaalp C, Rychkova A, Vincenti L, Dezi A, Picciariello A
Department of Faculty Surgery No. 2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
General Surgery Unit "M. Rubino", Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy.
Tech Coloproctol. 2024 Dec 30;29(1):36. doi: 10.1007/s10151-024-03077-0.
Level of lymph nodes dissection (LND) and inferior mesenteric artery (IMA) ligation is still matter of debate of radical resection of colorectal cancer. This study aims to compare the short-term outcome of three different surgical techniques to treat sigmoid cancer: low ligation (LL) of the IMA with D3-LND, low IMA ligation with D2-LND, and high ligation (HL) of the IMA with D3-LND.
Patients affected by sigmoid colon cancer, who underwent radical resection with three different techniques (LL and D3-LND Group A, HL and D3-LND Group B, and LL with D2 LND- Group C), were included. Operative time (min), blood loss (ml), early postoperative complications, and number of harvested lymph nodes were compared.
Thirty patients per group were enrolled. The median operation time was shorter in group C (130 min, interquartile range [IQR] 120-140), compared with the 245 min (IQR 193.8-295.5) of group A and 257 min (IQR 183-345) of group B, p < 0.005. No significant differences between A and B group were observed in the median intraoperative blood loss, while group C had higher intraoperative blood loss (200 ml, IQR 200-260, p = 0.002). Anastomotic leak occurred in three patients belonging to group B. A reduced number of harvested lymph nodes was registered in Group C (14 lymph nodes, IQR 10-17), p < 0.005.
Both high and low tie ligation with D3-LND for sigmoid cancer can be considered safe and feasible with low rate of postoperative complications, allowing a higher number of harvested lymph nodes compared to low tie ligation with D2 lymphadenectomy.
在结直肠癌根治性切除术中，淋巴结清扫（LND）的范围和肠系膜下动脉（IMA）的结扎方式仍存在争议。本研究旨在比较三种不同手术技术治疗乙状结肠癌的短期疗效：IMA低位结扎（LL）联合D3淋巴结清扫、IMA低位结扎联合D2淋巴结清扫以及IMA高位结扎（HL）联合D3淋巴结清扫。
纳入接受三种不同技术（LL联合D3淋巴结清扫的A组、HL联合D3淋巴结清扫的B组以及LL联合D2淋巴结清扫的C组）根治性切除的乙状结肠癌患者。比较手术时间（分钟）、失血量（毫升）、术后早期并发症以及获取的淋巴结数量。
每组纳入30例患者。C组的中位手术时间较短（130分钟，四分位间距[IQR]为120 - 140），而A组为245分钟（IQR为193.8 - 295.5），B组为257分钟（IQR为183 - 345），p < 0.005。A组和B组的中位术中失血量无显著差异，而C组的术中失血量较高（200毫升，IQR为200 - 260，p = 0.002）。B组有3例患者发生吻合口漏。C组获取的淋巴结数量减少（14个淋巴结，IQR为10 - 17），p < 0.005。
乙状结肠癌采用D3淋巴结清扫的高位和低位结扎均可认为是安全可行的，术后并发症发生率低，与D2淋巴结清扫的低位结扎相比，可获取更多的淋巴结。
