腹腔镜右半结肠癌扩大切除术意义的纷争

Dispute of the clinical significance of laparoscopic complete mesocolic excision and extended(D3)lymphadenectomy for right colon cancer

随着全结肠系膜切除(CME)及扩大淋巴结清扫(D3)理念在结肠癌手术中的推广,CME及D3淋巴结清扫上取得了良好的肿瘤学和手术结果,提高生存率及无病生存率,降低局部复发率。CME手术与直肠癌术中直肠系膜全切除相似,是切除肿瘤引流区域的所有淋巴、血管和神经组织以及完整的肠系膜,腹膜和包围的筋膜。而D3淋巴结清扫也是基于相似的原则。但是,目前有证据表明CME和D3淋巴结清扫的预后获益受限于方法缺陷和一些潜在的混杂因素,需要大宗病例的前瞻随机对照临床实验进一步验证。

With the introduction and popularization of complete mesocolic excision（ CME） and extended lymphadenectomy（ D3） for the surgical treatment of right colon cancer,expert practitioners have achieved excellent good pathological results as well as good improvements in overall survival,disease free survival and local recurrence. Similar to total mesorectal excision（ TME） for rectal cancer,CME surgery follows the same oncological principles that is removal of all lymphatic,vascular,and neural tissue in the drainage area of the tumour in a complete mesocolic envelope with intact mesentery,peritoneum and encasing fascia. D3 has the same equivalent procedures based on the similar principle. However,there is conflicting evidence that the benefit of CME or D3 is limited by methodological defects and some potential confounding factors,therefore,there is still an urgent need for large cases of randomized controlled long-term observation research.