5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study
5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study
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DOI：
10.1016/s1470-2045(19)30485-1
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发表时间：
2019-11-01
期刊：
影响因子：
51.1
通讯作者：
Kleif, Jakob
中科院分区：
文献类型：
--
作者：
Bertelsen, Claus A.;Neuenschwander, Anders U.;Kleif, Jakob
背景广泛淋巴结清扫术作为结肠系膜完全切除术的优点仍有争议，尽管最近的研究表明其与改善长期预后有关。然而，这些研究都没有一个意向治疗的设计或旨在显示因果关系的影响，因此在这项研究中，我们的目的是估计因果肿瘤治疗效果完全结肠系膜切除右侧coloncancer.Methods我们做了一个以人群为基础的队列研究，涉及前瞻性数据收集从丹麦的四家医院。我们比较了一个中心在几乎完全暴露上级肠系膜静脉近端部分后进行中央淋巴结清扫和血管分离的患者（即完全结肠系膜切除组）与其他三个中心进行常规切除和非标准化和有限淋巴结清扫的患者（即非完全结肠系膜切除;对照组）的肿瘤学结局数据。我们纳入了2008年6月1日至2013年12月31日期间，丹麦丹麦首都地区所有接受择期根治性右侧结肠切除术治疗I-III期结肠癌（根据国际癌症控制联盟（UICC;第5版）分类）的患者的数据。术后随访5.2年。主要结局是手术后5.2年的累积复发率。采用治疗权重的逆概率和竞争风险分析来估计完全结肠系膜切除的可能因果效应。该研究在www.example.com注册，编号NCT 03754075。结果1069例患者（对照组813例，完全结肠系膜切除组256例）在研究期间接受了治疗性选择性手术治疗右侧结肠癌。没有患者在生存或复发状态方面失访，因此在分析中没有患者被删失。完全结肠系膜切除组的5.2年累积复发率为9.7%（95%CI 6.3 - 13.1），而对照组为17.9%（15.3 - 20.5），完全结肠系膜切除5.2年后的绝对风险降低为8.2%（95%CI 4.0 - 12.4; p = 0.00015）。在对照组中，813名患者中有145名（18%）被诊断出复发，281名（35%）在随访期间死亡，而在完全结肠系膜切除组中，256例患者中有25例（10%）被诊断为复发，75例（29%）在随访期间死亡。本研究显示了中央结肠系膜淋巴结切除术对右侧结肠腺癌切除术后复发风险的因果治疗效果。完整的结肠系膜切除术有可能降低复发风险，改善所有UICC I-III期右侧结肠腺癌切除术后的长期结局。
Background The benefits of extensive lymph node dissection as performed in complete mesocolic excision are still debated, although recent studies have shown an association with improved long-term outcomes. However, none of these studies had an intention-to-treat design or aimed to show a causal effect; therefore in this study, we aimed to estimate the causal oncological treatment effects of complete mesocolic excision on right-sided colon cancer.Methods We did a population-based cohort study involving prospective data collected from four hospitals in Denmark. We compared the oncological outcome data of patients at one centre performing central lymph node dissection and vascular division after almost complete exposure of the proximal part of the superior mesenteric vein (ie, the complete mesocolic excision group) with three other centres performing conventional resections with unstandardised and limited lymph node dissection (ie, non-complete mesocolic excision; control group). We included data for all patients in the Capital Region of Denmark undergoing elective curative-intent right-sided colon resections for stages I-III colon cancer, as categorised by the Union for International Cancer Control (UICC; 5th edition), from June 1, 2008, to Dec 31, 2013. Patients were followed-up for 5.2 years after surgery. The primary outcome was the cumulative incidence of recurrence after 5.2 years of surgery. Inverse probability of treatment weighting and competing risk analyses were used to estimate the possible causal effects of complete mesocolic excision. This study is registered with ClinicalTrials.gov, number NCT03754075.Findings 1069 patients (813 in the control group and 256 in the complete mesocolic excision group) underwent curative-intent elective surgery for right-sided colon cancer during the study period. None of the patients were lost to follow-up regarding survival or recurrence status, and consequently no patient was censored in the analyses. The 5.2-year cumulative incidence of recurrence was 9.7% (95% CI 6.3-13.1) in the complete mesocolic excision group compared with 17.9% (15.3-20.5) in the control group, and the absolute risk reduction of complete mesocolic excision after 5.2 years was 8.2% (95% CI 4.0-12.4; p=0 .00015). In the control group, 145 (18%) of 813 patients were diagnosed with a recurrence and 281 (35%) died during follow-up, whereas in the complete mesocolic excision group 25 (10%) of 256 patients were diagnosed with a recurrence and 75 (29%) died during follow-up.Interpretation This study shows a causal treatment effect of central mesocolic lymph node excision on risk of recurrence after resection for right-sided colon adenocarcinoma. Complete mesocolic excision has the potential to reduce the risk of recurrence and improve long-term outcome after resection for all UICC stages I-III of right-sided colon adenocarcinomas.