Extent of surgery in cancer of the colon:Is more better?

作     者：Wouter Willaert Wim Ceelen 

作者机构：Department of SurgeryGhent University HospitalB-9000 GhentBelgium 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2015年第21卷第1期

页      面：132-138页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by The Fund for Scientific Research-Flanders(FWO)to Ceelen W(Senior Clinical Researcher) 

主　　题：Colon Adenocarcinoma Surgery Cancer Mesocolic exci 

摘      要：Since the introduction of total mesorectal excision as the standard approach in mid and low rectal cancer,the incidence of local recurrence has sharply *** attention to surgical technique in colon cancer(CC) has resulted in the concept of complete mesocolic excision(CME),which consists of complete removal of the intact mesentery and high ligation of the vascular supply at its *** renewed attention to meticulous surgical technique certainly has its merits,routine implementation of CME is currently ***,in contrast to rectal cancer,local recurrence originating from an incompletely removed mesenteryis rare in CC and usually a manifestation of systemic ***,although CME may increase nodal counts and therefore staging accuracy,this is unlikely to affect survival since the observed relationship between nodal counts and outcome in CC is most probably not causal but confounded by a range of clinical ***,several lines of evidence suggest that metastasis to locoregional nodes occurs early and is a stochastic rather than a stepwise phenomenon in CC,in essence reflecting the tumor-host-metastasis ***,therefore,comparative studies in CC as well as in other digestive cancers have failed to demonstrate any survival benefit associated with extensive,additional or extra-mesenteric ***,routine implementation of CME may cause patient harm by longer operating times,major vascular damage and autonomic nerve ***,data from randomized trials reporting relevant endpoints are required before CME can be recommended as a standard approach in CC surgery.