D3 Lymph Node Dissection in Right Hemicolectomy with a No-touch Isolation Technique in Patients With Colon Cancer
D3 Lymph Node Dissection in Right Hemicolectomy with a No-touch Isolation Technique in Patients With Colon Cancer
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DOI：
10.1097/dcr.0b013e3182919093
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发表时间：
2013-07-01
影响因子：
3.9
通讯作者：
Kato, Tomoyuki
中科院分区：
文献类型：
--
作者：
Kanemitsu, Yukihide;Komori, Koji;Kato, Tomoyuki
背景：淋巴结清扫术在右半结肠癌治疗中的作用仍存在争议。目的：本研究的目的是通过使用无接触隔离技术的D3淋巴结清扫术，研究可治愈的右半结肠癌的外科治疗，并确定对右半结肠癌预后最佳的淋巴结清扫范围。设计：本研究是一项前瞻性收集数据库的回顾性队列研究。设置：调查发生在一个专业的结直肠外科。患者：370例因右侧结肠癌接受D3淋巴结清扫术的连续患者的数据，主要观察指标：确定了沿沿着上级肠系膜血管通过右结肠系膜中间淋巴结的结肠动脉干根部主要淋巴结受累患者的生存率。结果：I期（n = 73，19.7%）、II期（n = 155，41.9%）和III期（n = 142，38.4%）患者的5年总生存率分别为94.5%、87.6%和79.2%。I期、II期和III期癌症患者的5年疾病特异性生存率分别为100.0%、94.5%和85.0%。主淋巴结转移11例（3.0%），中间淋巴结转移49例（13.2%）。主淋巴结转移患者的5年总生存率和疾病特异性生存率均为36.4%，中间淋巴结转移患者的5年总生存率和疾病特异性生存率分别为77.6%和83.5%。局限性：本研究受其非随机回顾性设计的限制。采用非接触隔离技术的D3淋巴结切除术允许根治性切除和长期-一组右半结肠癌患者的长期生存率。
BACKGROUND:The role of lymph node dissection in the management of right-sided colon cancer remains controversial.OBJECTIVE:The aim of this study was to investigate the surgical treatment of curable right-sided colon cancer by using D3 lymphadenectomy with a no-touch isolation technique and to determine the extent of lymph node dissection optimal for the prognosis of right-sided colon cancer.DESIGN:This research is a retrospective cohort study from a prospectively collected database.SETTING:The investigation took place in a specialized colorectal surgery department.PATIENTS:Data on 370 consecutive patients who underwent D3 lymph node dissection for right-sided colon cancer with a no-touch isolation technique were identified.MAIN OUTCOME MEASURES:The survival of patients with involvement of main nodes at the roots of colonic arterial trunks along superior mesenteric vessels through intermediate nodes in the right mesocolon was determined.RESULTS:The 5-year overall survival of patients with stage I (n = 73, 19.7%), II (n = 155, 41.9%), and III (n = 142, 38.4%) cancer were 94.5%, 87.6%, and 79.2%. The 5-year disease-specific survival of patients with stages I, II, and III cancer were 100.0%, 94.5%, and 85.0%. Eleven patients (3.0%) had metastatic involvement of main lymph nodes, whereas 49 (13.2%) had metastases to intermediate lymph nodes. The 5-year overall survival and disease-specific survival of patients with metastases to main lymph nodes were 36.4% for both, and 5-year overall survival and disease-specific survival of patients with metastases to intermediate lymph nodes were 77.6% and 83.5%.LIMITATIONS:This study was limited by its nonrandomized retrospective design.CONCLUSIONS:D3 lymphadenectomy with a no-touch isolation technique allows curative resection and long-term survival in a cohort of patients with cancer of the right colon.