右半结肠癌D_(3)淋巴清扫术与完整结肠系膜切除术的异同

Similarities and differences between D_(3) lymphadenectomy and complete mesocolic excision of right hemicolonectomy

结肠癌D_(3)淋巴清扫术和完整结肠系膜切除术(CME)是目前全球的两大主流手术理念,从传入我国到发展,已有十余年的历史。但是,国内学术界对这两个手术的核心理念以及两者的异同,仍然有着许多不同的理解和误会,目前鲜见针对该问题进行过专门探讨的文章。尤其对于右半结肠癌D_(3)和CME手术,国内学者的理解较为混乱,目前主要存在将两种理念相混淆的"D_(3)等同于CME"理念以及将两种概念进行优势互补的"D_(3)+CME"理念,前者把两者同一化,后者似乎把两者概念完全不同区别对待,孰是孰非,未达成共识。本文阐述右半结肠癌D_(3)手术和CME手术在提出背景、手术原理、手术范围以及根治效果等方面存在的较大差异,认为两者不属于同一概念,而且右半结肠癌CME手术范围大于且包含D3手术范围,两者也不属于互补关系。

D_(3) lymphadenectomy and complete mesocolic excision(CME)for colon cancer,which have been introduced to China for more than 10 years,are two major surgical principles worldwide.However,there are still many different opinions and misunderstandings about the core principles of D_(3) and CME,especially the similarities and differences between them.However,few articles have been published to discuss these issues specifically.Domestic scholars'understandings about D_(3) lymphadenectomy and CME for right hemicolectomy are quite different.Two different concepts including"D_(3)/CME"and"D_(3)+CME"have become mainstream views.The former equate D3 with CME and the latter seems to regard them as totally different principles.There is no consensus on which one is more reasonable.Therefore,this article aims to discuss the similarities and differences between D_(3) and CME for right hemicolectomy in perspectives of the theoretical background,surgical principles,extent of surgery and oncological outcomes.We believed that D3 and CME do not belong to the same concept,and that the scope of CME surgery for right-sided colon cancer is greater than and includes the scope of D3 surgery,and that D_(3) and CME are not complementary.