A retrospective study on laparoscopic complete mesocolic excision via dorsal-medial hybrid approach for right colon cancer

doi:10.16139/j.1007-9610.2020.03.008

Abstract

Abstract:

Objective To investigate pathologic effects combined with postoperative results on right colon cancer with laparoscopic complete mesocolic excision(CME) via dorsal-medial hybrid approach compared with traditional medial approach. Methods A total of 68 patients with right colon cancer undergoing laparoscopic CME in our hospital between Ja-nuary and June 2017 were studied retrospectively. There were two groups including 37 cases in dorsal-medial hybrid group and 31 cases in traditional medial group. CME quality evaluated with the method proposed by West et al along with safety, short-term results and long-term prognosis were compared between two groups. Results CME completion rate was 86.5% in dorsal-medial hybrid group and 80.6% in traditional medial group without statistical difference(P=0.53). Laparoscopic dissection time in dorsal-medial group was significantly shorter than that in traditional medial group[(62.70±12.22) min vs.(70.39±11.98) min, P=0.01]. There was no statistical difference in operation time, blood loss, postoperative flatus time, postoperative complications and long-term prognosis of the patients between two groups. Conclusions Laparoscopic CME via dorsal-medial hybrid approach for right colon cancer could have less laparoscopic dissection time, and two approaches were similar in CME quality, safety and prognosis.

Key words: Colon cancer, Complete mesocolic excision, Laparoscopic radical resection for right colon cancer, Dorsal-medial hybrid approach, Traditional medial approach

CLC Number:

R735.3⁺5

LIU Haishan, CAI Zhenghao, MA Junjun, SUN Jing, HE Zirui, ZANG Lu, DONG Feng, FENG Bo, ZONG Yaping, XUE Pei, ZHANG Luyang, LU Aiguo, ZHENG Minhua. A retrospective study on laparoscopic complete mesocolic excision via dorsal-medial hybrid approach for right colon cancer[J]. Journal of Surgery Concepts & Practice, 2020, 25(03): 211-216.

Figures/Tables 13

References 27

[1]	Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome[J]. Colorectal Dis, 2009, 11(4):354-364. doi: 10.1111/j.1463-1318.2008.01735.x pmid: 19016817
[2]	郑民华, 马君俊. 腹腔镜右半结肠癌根治术的难点与争议[J]. 中华普外科手术学杂志(电子版), 2018, 12(3):181-184.
[3]	郑民华, 马君俊. 腹腔镜右半结肠完整结肠系膜切除术[J]. 中华腔镜外科杂志(电子版), 2015, 8(1):1-4.
[4]	He Z, Zhang S, Xue P, et al. Completely medial access by page-turning approach for laparoscopic right hemi-colectomy: 6-year-experience in single center[J]. Surg Endosc, 2019, 33(3):959-965. doi: 10.1007/s00464-018-6525-1 URL
[5]	Feng B, Ling TL, Lu AG, et al. Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer[J]. Surg Endosc, 2014, 28(2):477-483. doi: 10.1007/s00464-013-3225-8 pmid: 24114515
[6]	郑民华. 腹腔镜右半结肠癌CME切除术——尾侧中间联合入路[J]. 中华普外科手术学杂志(电子版), 2018, 12(3):198.
[7]	West NP, Morris EJ, Rotimi O, et al. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study[J]. Lancet Oncol, 2008, 9(9):857-865. doi: 10.1016/S1470-2045(08)70181-5 URL
[8]	West NP, Hohenberger W, Weber K, et al. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon[J]. J Clin Oncol, 2010, 28(2):272-278. doi: 10.1200/JCO.2009.24.1448 URL
[9]	Siani LM, Garulli G. The importance of the mesofascial interface in complete mesocolic excision[J]. Surgeon, 2017, 15(4):240-249. doi: 10.1016/j.surge.2016.10.006 URL
[10]	Gao Z, Ye Y, Zhang W, et al. An anatomical, histopathological, and molecular biological function study of the fascias posterior to the interperitoneal colon and its associated mesocolon: their relevance to colonic surgery[J]. J Anat, 2013, 223(2):123-132. doi: 10.1111/joa.12066 URL
[11]	Faerden AE, Sjo OH, Bukholm IRK, et al. Lymph node micrometastases and isolated tumor cells influence survival in stage Ⅰ and Ⅱ colon cancer[J]. Dis Colon Rectum, 2011, 54(2):200-206. doi: 10.1007/DCR.0b013e3181fd4c7c pmid: 21228669
[12]	叶颖江, 高志冬. 在争议中前行:完全结肠系膜切除术的安全性与有效性[J]. 外科理论与实践, 2018, 23(5):405-408.
[13]	Wang C, Gao Z, Shen K, et al. Safety, quality and effect of complete mesocolic excision vs non-complete mesoco-lic excision in patients with colon cancer: a systemic review and meta-analysis[J]. Colorectal Dis, 2017, 19(11):962-972. doi: 10.1111/codi.13900 pmid: 28949060
[14]	Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery[J]. Br J Surg, 2016, 103(5):581-589. doi: 10.1002/bjs.10083 pmid: 26780563
[15]	West NP, Kobayashi H, Takahashi K, et al. Understan-ding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation[J]. J Clin Oncol, 2012, 30(15):1763-1769. doi: 10.1200/JCO.2011.38.3992 URL
[16]	Matsuda T, Iwasaki T, Mitsutsuji M, et al. Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy[J]. Surg Endosc, 2015, 29(4):1001. doi: 10.1007/s00464-014-3761-x pmid: 25135445
[17]	Oshiro T, Komori K, Kinoshita T, et al. Laparoscopic right hemicolectomy with radical lymph node dissection along the superior mesenteric artery using a multidirectional approach[J]. Dis Colon Rectum, 2019, 62(5):638. doi: 10.1097/DCR.0000000000001300 URL
[18]	Cho MS, Baek SJ, Hur H, et al. Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors[J]. Ann Surg, 2015, 261(4):708-715. doi: 10.1097/SLA.0000000000000831 URL
[19]	池畔. 选择尾侧入路[J]. 中华胃肠外科杂志, 2016, 19(8):875-877.
[20]	Wang Y, Zhang C, Zhang D, et al. Clinical outcome of laparoscopic complete mesocolic excision in the treatment of right colon cancer[J]. World J Surg Oncol, 2017, 15(1):174-176. doi: 10.1186/s12957-017-1236-y URL
[21]	Mori S, Kita Y, Baba K, et al. Laparoscopic complete mesocolic excision via combined medial and cranial approaches for transverse colon cancer[J]. Surg Today, 2017, 47(5):643-649. doi: 10.1007/s00595-016-1409-2 URL
[22]	Prevost GA, Odermatt M, Furrer M, et al. Postoperative morbidity of complete mesocolic excision and central vascular ligation in right colectomy: a retrospective compa-rative cohort study[J]. World J Surg Oncol, 2018, 16(1):214-218. doi: 10.1186/s12957-018-1514-3 pmid: 30376849
[23]	张森, 冯波. 完整结肠系膜切除术在结肠癌中的应用[J]. 外科理论与实践, 2016, 21(1):83-86.
[24]	舒若, 刘童蕾, 田衍, 等. 尾侧入路与中间入路行腹腔镜下右半结肠癌根治术临床对比[J]. 昆明医科大学学报, 2018, 39(5):78-82.
[25]	肖荷芳, 陈子文, 刘红权, 等. 腹腔镜右半结肠切除尾侧入路与头侧入路的前瞻性随机对照研究[J]. 现代医院, 2018, 18(11):1654-1657.
[26]	叶进军, 辛乐, 刘继东, 等. 尾侧入路法腹腔镜右半结肠癌根治性切除术的临床体会[J]. 腹腔镜外科杂志, 2018, 23(3):170-174.
[27]	郑毅, 白霞, 许鑫, 等. 腹腔镜尾侧入路右半结肠癌根治术的临床疗效探讨[J]. 现代消化及介入诊疗, 2019, 24(2):162-164.

项目	尾侧联合入路（n=37)	中间入路（n=31)	P值
年龄（岁）	63.38±11.37	64.26±15.22	0.78
性别（男/女）	17/20	18/13	0.34
BMI	23.50±3.18	22.90±5.25	0.56
腹部手术史			0.69
无	29	23
有	8	8
ASA分级			0.80
Ⅰ	7	4
Ⅱ	22	20
Ⅲ	8	7
肿瘤部位			0.23
回盲部	8	9
升结肠	9	6
肝曲及横结肠	20	16
术后辅助治疗			0.38
无	23	16
有	14	15

项目	尾侧联合入路（n=37)	中间入路（n=31)	P值
腺癌			0.06
低分化	3	10
中分化	29	16
高分化	2	2
黏液腺癌	3	3
T分期			0.38
T₂	4	2
T₃	29	22
T₄	4	7
N分期			0.23
N₀	28	18
N₁	8	10
N₂	1	3
分期			0.53
Ⅰ	4	2
Ⅱ	22	16
Ⅲ	11	13

项目	尾侧联合入路 (n=37)	中间入路 (n=31)	P值
总手术时间（min)	134.59±38.56	144.93±43.98	0.79
腹腔镜下解剖时间（min）	62.70±12.22	70.39±11.98	0.01
出血量（mL）	30.41±29.64	38.23±24.34	0.25
术后排气时间（d）	2.78±0.79	2.81±0.83	0.91
术后住院时间（d）	7.91±1.57	8.00±1.56	0.82
术后近期并发症	4（10.8%）	2（6.5%）	0.68
切口并发症	1	1
吻合口漏	0	1
肠梗阻	2	0
出血	1	0

项目	尾侧联合入路 (n=37)	中间入路 (n=31)	P值
CME完成率	86.5%（32）	80.6%（25）	0.53
系膜完整性分级
系膜层面（a级）	32	25
系膜内层面（b级）	5	6
切除系膜面积（cm²）	104.92±29.84	106.33±30.68	0.86
血管结扎部位
A线(cm)	9.77±2.42	10.24±1.97	0.43
B线(cm)	8.39±2.04	8.72±1.66	0.51
切除结肠长度（cm)	17.45±4.72	19.98±4.99	0.47
淋巴结清扫数(枚）	20.93±6.34	20.29±6.83	0.71