Standardized surgery for colonic cancer: complete mesocolic excision and central ligation - technical notes and outcome
Standardized surgery for colonic cancer: complete mesocolic excision and central ligation - technical notes and outcome
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DOI：
10.1111/j.1463-1318.2008.01735.x
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发表时间：
2009-05-01
影响因子：
3.4
通讯作者：
Merkel, S.
中科院分区：
文献类型：
--
作者：
Hohenberger, W.;Weber, K.;Merkel, S.
全直肠系膜切除术（TME）是20多年前由R. J. Heald提出的一种直肠癌手术方式，目前已被世界广泛接受。这种技术的重点是肿瘤及其主要淋巴引流的完整包裹。这一概念可以转化为结肠癌手术，因为直肠系膜只是覆盖结肠及其淋巴引流的肠系膜平面的一部分。根据直肠癌全直肠系膜切除的概念，我们提出了结肠癌全直肠系膜切除的概念。本文分析了1978 ~ 2002年我科1329例结肠癌RO切除术的临床资料。通过随后的应用程序的CME，我们能够降低局部5年复发率在结肠癌从1978年至1984年期间的6.5%，在1995年至2002年的3.6%。同期，结肠癌根治性切除患者的5年生存率从82.1%提高到89.1%。结肠癌手术中的CME技术旨在获得完整的标本和最大限度的淋巴结收获。这意味着更低的局部复发率和更好的总体生存率。
Total mesorectal excision (TME) as proposed by R.J. Heald more than 20 years ago, is nowadays accepted worldwide for optimal rectal cancer surgery. This technique is focused on an intact package of the tumour and its main lymphatic drainage.This concept can be translated into colon cancer surgery, as the mesorectum is only part of the mesenteric planes which cover the colon and its lymphatic drainage like envelopes. According to the concept of TME for rectal cancer, we perform a concept of complete mesocolic excision (CME) for colonic cancer. This technique aims at the separation of the mesocolic from the parietal plane and true central ligation of the supplying arteries and draining veins right at their roots.Prospectively obtained data from 1329 consecutive patients of our department with RO-resection of colon cancer between 1978 and 2002 were analysed. Patient data of three subdivided time periods were compared.By consequent application of the procedure of CME, we were able to reduce local 5-year recurrence rates in colon cancer from 6.5% in the period from 1978 to 1984 to 3.6% in 1995 to 2002. In the same period, the cancer related 5-year survival rates in patients resected for cure increased from 82.1% to 89.1%.The technique of CME in colon cancer surgery aims at a specimen with intact layers and a maximum of lymphnode harvest. This is translated into lower local recurrence rates and better overall survival.