腹腔镜右半结肠癌根治术切除范围争议与共识

Controversy and consensus on the scope of laparoscopic radical surgery for right colon cancer

基于完整结肠系膜切除(CME)与D3淋巴结清扫理念,腹腔镜右半结肠癌根治术的手术范围已基本形成共识,但在部分细节问题上仍存在争议。在肠管切除范围方面,尽管“10+5”原则得到临床的广泛应用,但在实施CME和D3根治术时,肠管切除范围仍存在争议。针对肝曲癌和右侧横结肠癌,能否实施保留回盲部的右半结肠癌根治术仍需进一步论证。在淋巴结清扫范围方面,对于D3淋巴结清扫的内侧界仍持有不同观点,现有的证据表明行肠系膜上动脉左侧淋巴结清扫具有一定的临床价值。针对肝曲癌和右侧横结肠癌,是否常规行幽门下和胃网膜弓淋巴结清扫尚无定论。目前,我国学者已开展一系列高质量临床研究,对上述争议问题进行探究。

Based on the concepts of complete mesocolon excision(CME)and D3 lymphadenectomy,the surgical scope of laparoscopic right hemicolectomy has formed a consensus,but controversy still exists in some details.In terms of the extent of intestinal resection,although the“10+5”principle has been widely used in clinical practice,there are still differences in the extent of intestinal resection when performing CME and D3 lymphadenectomy.For hepatic flexure and right transverse colon tumors,the feasibility of performing laparoscopic ileocecal-sparing right hemicolectomy(LISH)still needs to be demonstrated.Regarding the extent of lymph node dissection,there are still different views on the medial boundary of D3 lymphadenectomy,and the available evidence suggests that laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery has some clinical value.For hepatic flexure and right transverse colon tumors,whether to routinely perform infrapyloric and gastroepiploic lymph nodes(IGLN)dissection is still inconclusive.Currently,Chinese scholars have conducted a series of high-quality clinical studies to investigate the above controversial issues.