Diseases of the colon and rectum · 2021
The Medial Border of Laparoscopic D3 Lymphadenectomy for Right Colon Cancer: Results from an Exploratory Pilot Study.
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Zhou Leqi, Diao Dechang, Ye Kai, Feng Yifei, Yi Xiaojiang, Tong Weihua, Xu Jianhua, Su Hao, Wang Yong, He Liang, He Zirui, Xu Ziwei, Lu Xinquan, Lin Jianan, Zhang Jiaxin, Xue Pei, Zhang Dongsheng, Li Hongming, Ma Junjun, Kang Wengui, Yang Xiao, Li Jianwen, Cai Tianyi, Lu Aiguo, Liu Shiguang, Sun Jing, Zhang Sen, Zheng Minhua, Wang Quan, Sun Yueming, Feng Bo
Аннотация
BACKGROUND: Opinions vary on the medial border of D3 lymphadenectomy for right colon cancer. Most surgeons place the medial border along the left side of the superior mesenteric vein, but some consider the left side of the superior mesenteric artery as the medial border.
OBJECTIVES: This study investigated the clinical outcomes of laparoscopic D3 lymphadenectomy for right colon cancer with the medial border along the left side of superior mesenteric artery.
DESIGN: This was a retrospective study.
SETTINGS: The study was conducted in specialized colorectal cancer department of 5 tertiary hospitals.
PATIENTS: Patients receiving laparoscopic D3 lymphadenectomy for right colon cancer from January 2013 to December 2018 were included.
MAIN OUTCOME MEASURES: After propensity score matching, 307 patients receiving laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery were assigned to the superior mesenteric artery group and 614 patients were assigned to the superior mesenteric vein group. Univariate, multivariate, and Kaplan-Meier analyses were performed to assess the clinical data.
RESULTS: The short-term outcomes were similar between the 2 groups; however, the superior mesenteric artery group had a higher rate of chylous leakage (p < 0.001). More lymph nodes were harvested from the superior mesenteric artery group than from the superior mesenteric vein group (p = 0.001). The number (p = 0.005) of metastatic lymph nodes and the lymph node ratio (p = 0.041) in main nodes were both higher in the superior mesenteric artery group. The 2 groups had similar long-term survival, but the superior mesenteric artery group tended to show better disease-free survival in patients with stage disease III (p = 0.056).
LIMITATIONS: This was a retrospective, nonrandomized study.
CONCLUSION: Laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery, except for a higher rate of chylous leakage, had short-term outcomes comparable to the superior mesenteric vein group. The superior mesenteric artery group tended to achieve better disease-free survival in patients with stage III disease, but further study is required to better elucidate differences in these approaches because risks/benefits do exist.
OBJECTIVES: This study investigated the clinical outcomes of laparoscopic D3 lymphadenectomy for right colon cancer with the medial border along the left side of superior mesenteric artery.
DESIGN: This was a retrospective study.
SETTINGS: The study was conducted in specialized colorectal cancer department of 5 tertiary hospitals.
PATIENTS: Patients receiving laparoscopic D3 lymphadenectomy for right colon cancer from January 2013 to December 2018 were included.
MAIN OUTCOME MEASURES: After propensity score matching, 307 patients receiving laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery were assigned to the superior mesenteric artery group and 614 patients were assigned to the superior mesenteric vein group. Univariate, multivariate, and Kaplan-Meier analyses were performed to assess the clinical data.
RESULTS: The short-term outcomes were similar between the 2 groups; however, the superior mesenteric artery group had a higher rate of chylous leakage (p < 0.001). More lymph nodes were harvested from the superior mesenteric artery group than from the superior mesenteric vein group (p = 0.001). The number (p = 0.005) of metastatic lymph nodes and the lymph node ratio (p = 0.041) in main nodes were both higher in the superior mesenteric artery group. The 2 groups had similar long-term survival, but the superior mesenteric artery group tended to show better disease-free survival in patients with stage disease III (p = 0.056).
LIMITATIONS: This was a retrospective, nonrandomized study.
CONCLUSION: Laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery, except for a higher rate of chylous leakage, had short-term outcomes comparable to the superior mesenteric vein group. The superior mesenteric artery group tended to achieve better disease-free survival in patients with stage III disease, but further study is required to better elucidate differences in these approaches because risks/benefits do exist.
Предметные рубрики MeSH
AdultAgedAged, 80 and overAnastomotic LeakCase-Control StudiesChyleColonic NeoplasmsDisease-Free SurvivalFemaleHumansKaplan-Meier EstimateLaparoscopyLymph Node ExcisionLymph NodesMaleMesenteric Artery, SuperiorMesenteric VeinsMiddle AgedNeoplasm StagingNon-Randomized Controlled Trials as TopicOutcome Assessment, Health CarePilot ProjectsPropensity ScoreRetrospective Studies