Laparoscopic right hemicolectomy oriented by superior mesenteric artery for right colon cancer: efficacy evaluation with a match-controlled analysis.
Laparoscopic right hemicolectomy oriented by superior mesenteric artery for right colon cancer: efficacy evaluation with a match-controlled analysis.
复制标题
肠系膜上动脉引导的腹腔镜右半结肠切除术治疗右结肠癌：匹配对照分析的疗效评价
DOI：
10.2147/cmar.s178148
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发表时间：
2018
影响因子：
3.3
通讯作者：
Yuan Y
中科院分区：
文献类型：
--
作者：
Dai W;Zhang J;Xiong W;Xu J;Cai S;Tan M;He Y;Song W;Yuan Y
以D3为原则的腹腔镜右半结肠切除术(LRC)是治疗右半结肠癌(RCC)的理想术式。本研究旨在评价肠系膜上动脉(SMA)引导下LRC(SLRC)治疗肾癌的临床疗效。从我们的数据库和电子病历中检索肾癌根治术患者的数据(2010年1月至2014年12月)。将SLRC手术与传统的腹腔镜右半结肠切除术(CLRC)进行比较，配对比例为1：2。比较两组患者围手术期和远期疗效。总之，选择了102名匹配的患者，中位随访时间为32个月(范围为3-68个月)。与CLRC组相比，SLRC组平均手术时间缩短(206.9比240.0分钟，P=0.007)，术后并发症发生率增加(14.7%比8.8%，P=0.499)。术后平均住院时间(7.4vs8.0d)、估计失血量(85.3vs105.4毫升)、淋巴结清扫数(28.4vs28.2)、阳性淋巴结数(0.6vs0.9)、总费用(4826.9美元vs4874.6美元)在两组间具有可比性(P>；0.05)。两组3年无瘤生存率(89.4%vs 92.1%，P=0.840)和总生存率(93.0%vs 83.1%，P=0.273)相似。高龄(≥65岁，P=0.049)和晚期肿瘤(≥II，P=0.009)是复发的独立危险因素。SLRC的围手术期和肿瘤学结果并不优于CLRC，但与CLRC相当。SMA引导下解剖是治疗肾癌的一种可行的手术方法。
Laparoscopic right hemicolectomy (LRC) with a principle of D3 lymphadenectomy seems to be appropriate in treatment of right-sided colon cancer (RCC). This study aimed to evaluate clinical efficacy of superior mesenteric artery (SMA)-guided LRC (SLRC) for RCC patients. Data for RCC patients with radical resection were retrieved from our database and electronic medical records (January 2010 to December 2014). Patients undergoing SLRC procedure were compared with those undergoing conventional laparoscopic right hemi-colectomy (CLRC), with a match ratio of 1:2 for group balance. Perioperative and long-term outcomes were compared between two groups. In sum, 102 matched patients were selected, with a median follow-up of 32 (range, 3–68) months. The mean operative time was significantly reduced in the SLRC group compared to the CLRC group (206.9 vs 240.0 minutes, P=0.007), with increased incidence of postoperative complications observed (14.7% vs 8.8%, P=0.499). Average length of stay after surgery (7.4 vs 8.0 days), estimated blood loss (85.3 vs 105.4 mL), number of harvested (28.4 vs 28.2) and positive (0.6 vs 0.9) lymph nodes, and overall costs ($4826.9 vs $4874.6) were comparable between two groups (P>0.05). The 3-year disease-free survival rate (89.4% vs 92.1%, P=0.840) and overall survival rate (93.0% vs 83.1%, P=0.273) were similar in both groups. Older age (≥65 years, P=0.049) and advanced tumor stage (≥II, P=0.009) were independent risk factors of recurrence. The perioperative and oncologic outcomes of SLRC were not superior, but comparable to CLRC. SMA-guided dissection was a feasible surgical approach in treatment of RCC.