Izukawa S, Numata M, Harada T, Atsumi Y, Kazama K, Sawazaki S, Godai T, Mushiake H, Higuchi A, Tamagawa H, Suwa Y, Watanabe J, Sato T, Saito A
Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Town, Minami-Ku, Yokohama City, Kanagawa, 232-0024, Japan.
Department of Surgery, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-Ku, Yokohama City, Kanagawa, 236-0004, Japan.
Tech Coloproctol. 2025 Jul 30;29(1):157. doi: 10.1007/s10151-025-03199-z.
Right-sided colon cancer surgery is a highly difficult operation, and ensuring perioperative safety is an important issue. While various approaches have been proposed for right-sided colon cancer, there are few reports comparing them. The present study compared the inferior approach (IA) and medial approach (MA) for right-sided colon cancer surgery and evaluated their safety.
We compared 528 cases of right-sided colon cancer surgery performed at our five affiliated institutions from 2017 to 2023, divided into IA and MA groups of 122 cases each using propensity score matching. Short-term outcomes of both groups were retrospectively evaluated, focusing on perioperative complications and perioperative mortality as the primary outcomes.
After propensity score matching, all baseline variables were well balanced. All patients underwent complete mesocolic excision. No statistically significant difference (p < 0.05) was observed between the two groups in the incidence of postoperative complications, and no cases of severe complications were observed in either group. The incidence rates of Clavien-Dindo grade ≥ 3 complications (IA/ MA): anastomotic leakage (0%/ 0.8%); intraabdominal abscess (0.8%/ 1.6%); surgical site infection (0.8%/ 3.2%); ileus (0%/ 0.8%); and anastomotic bleeding: (0%/ 0%). Postoperative hospital stay was significantly shorter in the IA group. Although there was a significant difference in the number of dissected lymph nodes, both groups had good R0 resection rates.
Both IA and MA represent safe and feasible approaches for right-sided colon cancer and can be selected on the basis of the surgeon's preference.
右半结肠癌手术是一项难度很高的手术，确保围手术期安全是一个重要问题。虽然针对右半结肠癌提出了多种手术入路，但比较这些入路的报道较少。本研究比较了右半结肠癌手术的 inferior 入路（IA）和 medial 入路（MA），并评估了它们的安全性。
我们比较了 2017 年至 2023 年在我们五家附属医院进行的 528 例右半结肠癌手术病例，使用倾向评分匹配法将其分为 IA 组和 MA 组，每组各 122 例。回顾性评估两组的短期结局，重点关注围手术期并发症和围手术期死亡率作为主要结局。
倾向评分匹配后，所有基线变量均得到良好平衡。所有患者均接受了完整的结肠系膜切除术。两组术后并发症发生率无统计学显著差异（p < 0.05），两组均未观察到严重并发症病例。Clavien-Dindo 分级≥3 级并发症的发生率（IA/MA）：吻合口漏（0%/0.8%）；腹腔内脓肿（0.8%/1.6%）；手术部位感染（0.8%/3.2%）；肠梗阻（0%/0.8%）；以及吻合口出血：（0%/0%）。IA 组术后住院时间明显更短。虽然清扫淋巴结数量有显著差异，但两组的 R0 切除率均良好。
IA 和 MA 都是右半结肠癌安全可行的手术入路，可根据外科医生的偏好进行选择。
