Comparison of outcomes of complete mesocolic excision with conventional radical resection performed by laparoscopic approach for right colon cancer

摘要

Background: This retrospective study compared the outcomes of laparoscopic complete mesocolic excision (CME) guided by superior mesenteric artery with laparoscopic conventional radical resection (CRR) performed for right-sided colon cancer. Methods: Patients with right-sided colon cancer underwent CME (n=107; January 2011 to December 2015) or CRR (n=60; January 2008 to December 2010). Results: The 2 groups were comparable regarding age, gender, body mass index, maximum tumor diameter, and tumor stage. In the CME group, the distances between the tumor and the high vascular tie (HVT; 12.6?cm), and between the closest bowel wall and HVT (10.4±0.9?cm) was significantly greater than that of the CRR group (11.5?cm and 9.3±1.0?cm, respectively; P 0.001). In the CME group, the number of retrieved lymph nodes (23.2) was significantly higher, and the volume of intraoperative bleeding (108.4?mL) was less than that of the CRR (14.0 and 128.7?mL; P 0.001). The length of resected bowel in the 2 groups was similar (25.8±0.7?cm and 25.5±2.1?cm; P =0.106), as was the operative time, postoperative hospitalization, time of first bowel movement, and complications. The 3-year recurrence rate of the CME group (8.4%) was significantly lower than that of the CRR (20.0%), the 3-year overall survival was significantly higher (93.5% cf. 85.0%), and the survival rates of T4 stage, N1 stage, pTNM stage II, pTNM stage III and lympho vascular invasion were significantly higher ( P 0.05). The 2 groups were similar for survival rates of Tis, T1, T2, T3, N2 stage, pTNM stage I and perineural invasion ( P 0.05). Conclusion: CME for right-sided colon cancer guided by superior mesenteric artery has similar short-term outcomes, higher lymph node yield, and higher 3-year overall survival compared with CRR.