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Proceedings of Anticancer Research 2024年第4期8卷 157-162页

作者： Guodong Zhao Zhe Shi Liang Xue Shugang Sun Affiliated Hospital of Hebei Engineering University Handan 056000Hebei ProvinceChina

Objective:To study the clinical outcomes of complete mesocolic excision(CME)for right-sided colon cancer using 3D(three-dimensional)laparoscopy compared to 2D(two-dimensional)***:From January 2022 to December 2023,58 patients with right-sided colon cancer treated at the Affiliated Hospital of Hebei Engineering University were randomly divided into a 3D laparoscopy group(observation group)and a 2D laparoscopy group(control group),with 29 patients in each *** blood loss,postoperative time to first flatulence,length of hospital stay,and incidence of complications in both groups were ***:There was a statistically significant difference in intraoperative blood loss between the two groups(P0.05).However,there was a statistically significant difference in the length of hospital stay(P<0.05)and the incidence of complications(P<0.05)between the two ***:3D laparoscopy for CME can reduce intraoperative blood loss,shorten hospital stay,and decrease postoperative complications,showing significant clinical advantages over traditional 2D laparoscopy.

关键词： 3D laparoscopy 2D laparoscopy complete mesocolic excision Colon cancer

Does cranial-medial mixed dominant approach have a unique advantage for laparoscopic right hemicolectomy with complete mesocolic excision?

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World Journal of Gastrointestinal Surgery 2022年第3期14卷 221-235页

作者： Li Lin Si-Bo Yuan Huan Guo Department of Gastrointestinal Surgery and Xiamen City Key Laboratory of Gastrointestinal Cancer Zhongshan HospitalXiamen UniversityXiamen 361000Fujian ProvinceChina

BACKGROUND complete mesocolic excision(CME)with central vascular ligation(CVL)was proposed by Hohenberger in *** CME principle has gradually become the technical standard for colon cancer *** to achieve CME with CVL in laparoscopic right hemicolectomy(LRH)is controversial,and a unified standard approach is not yet *** recent years,the authors’team has integrated the theory of membrane anatomy,tried to combine the cephalic approach with the classic medial approach(MA)for technical optimization,and proposed a cranialmedial mixed dominant approach(CMA).AIM To explore the feasibility of operational approaches for LRH with *** In this retrospective cohort study,the clinical data of 57 patients with right-sided colon cancer(TNM stage I,II,or III)who underwent LRH with CME from January 2016 to June 2020 were collected and *** were 31 patients in the traditional MA group and 26 in the CMA *** There were no significant differences in baseline data between the two *** operation was shorter and the number of lymph nodes dissected was higher in the CMA group than in the MA group,but there was no significant difference in the number of positive lymph nodes,intraoperative blood loss,postoperative exhaust time,feeding time,postoperative hospital stay or postoperative complication *** Our study shows that the CMA is a safe and feasible procedure for LRH with CME and has a unique advantage.

关键词： Right hemicolectomy Laparoscopic surgery complete mesocolic excision Mesocolon Embryology Colon cancer

complete mesocolic excision: Lessons from anatomy translating to better oncologic outcome

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World Journal of Gastrointestinal Oncology 2016年第3期8卷 235-239页

作者： Min-Hua Zheng Sen Zhang Bo Feng Shanghai Minimally Invasive Surgery Center Ruijin Hospital Shanghai Jiao Tong University School of Medicine

Since the introduction of complete mesocolic excision(CME) for colon cancer, the oncologic outcome of patients has been greatly improved, which has led to a longer survival and a lower recurrence, just like the total mesorectum excision for rectal cancer. Despite the fact that the exact anatomy of the organ is one of the most vital things for surgeons to conduct surgery, no team has really studied the exact structure of the mesocolon and related attachments for CME, until the mesocolonic anatomy was first formally characterized in 2012. Therefore, this article mainly focuses on the anatomy development of the mesocolon and the achievement in this field. Meanwhile, we introduce the latest progress in laparoscopic surgery for colon cancer achieved by our team.

关键词： Colorectal cancer &ldquo Page-turning&rdquo approach Laparoscopic surgery complete mesocolic excision Toldt&rsquo s fascia

Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis

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World Journal of Gastrointestinal Oncology 2017年第12期9卷 475-491页

作者： Ionut Negoi Sorin Hostiuc Ruxandra Irina Negoi Mircea Beuran Department of General Surgery Emergency Hospital of Bucharest Carol Davila University of Medicine and Pharmacy Bucharest National Institute of Legal Medicine Mina Minovici Carol Davila University of Medicine and Pharmacy Bucharest Department of Anatomy Carol Davila University of Medicine and Pharmacy Bucharest Emergency Hospital of Bucharest Carol Davila University of Medicine and Pharmacy Bucharest

AIM To compare the effectiveness of laparoscopic complete mesocolic excision (CME) with central vascular ligation (L-CME) with its open (O-CME) counterpart. METHODS We conducted an electronic search of the PubMed/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, SciELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen (lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individual studies. RESULTS A total of one RCT and eleven CCTs (four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes (MD = -1.06, 95%CI: -3.65 to 1.53, P = 0.42), and tumor to high tie distance (MD = 14.26 cm, 95%CI: -4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group (MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions (OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall

关键词： Colon cancer complete mesocolic excision D3 lymphadenectomy Central vascular ligation

Feasibility and efficacy of laparoscopic radical right hemicolectomy with complete mesocolic excision using an‘artery-first’approach

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Gastroenterology Report 2019年第3期7卷 199-204,I0002页

作者： Xiao-Jiang Yi Xin-Quan Lu Hong-Ming Li Wei Wang Wen-Jun Xiong Jin Wan De-Chang Diao Department of Gastrointestinal(Tumor)Surgery Guangdong Province Hospital of Chinese MedicineThe Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo.111Dade RoadYuexiuGuangzhouGuangdong 86/510120China

Background:According to previous guidelines,the lymph nodes around the right side of the superior mesenteric artery(SMA)should be dissected and removed en ***,due to the technical challenge and the risk of complications,most surgeons perform the dissection along the axis of the superior mesenteric vein(SMV).Herein,we described an‘artery-first’approach for laparoscopic radical extended right hemicolectomy with complete mesocolic excision(CME).Methods:A total of 22 cases were collected from January to October *** right side of the SMA and SMV were exposed and separated,and the No.203,No.213 and No.223 lymph nodes were dissected en ***’s fascia was dissected and expanded laterally to the ascending colon,cranial to the pancreas *** caudal root of the mesentery and lateral attachments of the ascending colon were completely ***:There were 9 male and 13 female patients,with a mean age of 63.1(range,39–83)years and the mean body mass index was 24.6(range,18.3–37.7)kg/m^(2).The mean operative time was 192.5(range,145–240)minutes and the mean intraoperative blood loss was 55.0(range,10–300)*** mean number of harvested lymph nodes was 27.0(range,13–55)and the time to flatus and hospital stay were 35.0(range,26–120)hours and 7.5(range,5–20)days,*** complications occurred in two patients and no post-operative death was ***:The preliminary results suggest that the reported approach may be a feasible and safe procedure that is more in accordance with the principles of CME.

关键词： Laparoscopic right hemicolectomy complete mesocolic excision ‘artery-first’approach

Laparoscopic complete mesocolic excision: West meets East

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World Journal of Gastroenterology 2014年第39期20卷 14301-14307页

作者： Carina F K Chow Seon Hahn Kim Division of Colorectal Surgery Departmentof SurgeryRoyal Brisbane and Women’s HospitalBrisbaneQueensland 4029 Australia Department of General Surgery Mater Hospital South Brisbane Brisbane Queensland 4101 Australia Department of Surgery University of Queensland Brisbane Queensland 4072 Australia Colorectal Division Department of SurgeryKorea University Anam Hospital Anam-dongSeongbuk-gu Seoul 136-705 South Korea

complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.

关键词： complete mesocolic excision Colorectal surgery Laparoscopy Colonic neoplasms D3 lymphadenectomy

Historical development of mesenteric anatomy provides a universally applicable anatomic paradigm for complete/total mesocolic excision

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Gastroenterology Report 2014年第4期2卷 245-250页

作者： Rishabh Sehgal J.Calvin Coffey Centre for Interventions in Infection Inflammation and Immunity(4i)Graduate Entry Medical SchoolUniversity of LimerickIreland Department of Surgery University Hospitals Group LimerickLimerickIreland

Although total mesorectal excision has now become the‘gold standard’for the surgical management of rectal cancer,this is not so for colon *** data,provided by Hohenberger and West et *** others,have demonstrated excellent oncological outcomes when mesenterectomy is extensive(as is implicit in the concept of a‘high tie’)and the mesenteric package not *** studies highlight the importance of understanding the basics of the mesenteric organ(including the small intestinal mesentery,mesocolon,mesosigmoid and mesorectum)and of abiding to principles of planar *** this review,we first offer classic descriptions of the mesocolon and then detail contemporary *** so doing,we provide an anatomical basis for safe and effective complete mesocolic excision(CME)in the management of colon *** we list opportunities associated with the new anatomical paradigm,demonstrating benefits across multiple *** most importantly,we feel that a crystallized view of mesenteric anatomy will overcome factors that have hindered the general uptake of CME.

关键词： mesocolon mesenteric excision complete mesocolic excision Toldt’s fascia

Quality assessment of surgery for colorectal cancer:Where do we stand?

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World Journal of Gastrointestinal Surgery 2024年第4期16卷 982-987页

作者： Stefan Morarasu Cristian Livadaru Gabriel-Mihail Dimofte The Second Department of Surgical Oncology Regional Institute of OncologyIasi 707483Romania

Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past *** has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units *** mesorectal excision,complete mesocolic excision(CME),and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical ***,there are still ongoing discrepancies in outcomes largely based on surgeon *** is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume *** markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional *** the evolution of CME surgery,various quality markers have been described,mostly based on measurements on the surgical specimen and lymph node yield,while others have proposed radiological markers(*** stumps)measured on postoperative scans as part of the routine cancer *** is no ideal marker;however,taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.

关键词： Colorectal cancer Colon surgery Arterial stump complete mesocolic excision Surgical quality

Laparoscopic complete mesocolic excisions for colonic cancer in the last decade:Five-year survival in a single centre

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World Journal of Gastrointestinal Surgery 2017年第11期9卷 215-223页

作者： Kristian Eeg Storli Kristin Bentung Lygre Knut B?rge Iversen Maria Decap Geir Egil Eide Department of Surgery Haraldsplass Deaconess Hospital Department of Clinical Medicine University of Bergen Centre for Clinical Research Haukeland University Hospital Department of Global Public Health and Primary Care University of Bergen

AIM To analyse clinical and long-term oncologic results after laparoscopic complete mesocolic excision(CME) for colonic cancer over a 10-year *** Consecutive patients who received laparoscopic CME at our hospital from 2007 to 2017 were prospectively registered and retrospectively analysed. In total, 341 patients were included with tumour-nodal-metastasis(TNM) stages 0-Ⅲ.RESULTS The mean age of the patients was 71.9 years. The median length of stay was 5 d. The mean lymph node harvest was 17.8. The mortality rate was 1.2%. Fifteen patients were reoperated on for anastomotic leaks. The local recurrence rate was 2.3%. Five-year TTR and cancer-specific survival CSS were 83.1% and 90.3%. The location of the tumour was not a significant variable for survival in unadjusted and adjusted survival analysis. TNM stage and anastomotic leaks were significant variables with respect to *** Laparoscopic CME results in acceptable complication rates and long-term oncologic results. It is important to avoid anastomotic leaks because of their negative effect on survival.

关键词： complete mesocolic excision Central vascular ligature Colonic cancer Laparoscopic surgery Time to recurrence Cancer specific survival

Bowel function and quality of life after minimally invasive colectomy with D3 lymphadenectomy for right-sided colon adenocarcinoma

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World Journal of Gastroenterology 2020年第33期26卷 4972-4982页

作者： Ki-Myung Lee Se-Jin Baek Jung-Myun Kwak Jin Kim Seon-Hahn Kim Department of Surgery Korea University College of MedicineSeoul 02841South Korea

BACKGROUND Changes in bowel function after right-sided colectomy are not well understood compared to those associated with left-sided colectomy or rectal *** particular,there are concerns about bowel function after right-sided colectomy with complete mesocolic excision,which has become popular in the *** To evaluate the functional outcomes of patients who underwent right-sided colectomy with D3 lymphadenectomy for colon *** Functional data from patients who underwent minimally invasive right-sided colectomy for colon cancer from October 2017 to September 2018 were prospectively *** outcomes were evaluated preoperatively and at 3,6,12,and 18 mo *** Prior to surgery,57 patients answered the questionnaire,and 47 responded at three months,52 at 6 mo,52 at 12 mo,and 25 at 18 mo *** scales of quality of life and bowel function improved significantly over *** persisted to a high degree throughout the period without a significant change over *** use of medications for defecation was about 10%over the entire ***(P=0.023)and fecal frequency(P<0.001)increased,and bowel dysfunction group(P=0.028)was more common among patients taking *** six months,resected bowel and colon lengths were significantly different as a risk factor between the dysfunction group and the no dysfunction group[odd ratio(OR):1.095,P=0.026;OR:1.147,P=0.031,respectively]in univariate analysis,but not in multivariate *** Despite D3 lymphadenectomy,most bowel symptoms improved over time after right-sided colectomy using a minimally invasive approach,and continuous medication was needed in only approximately 10%of patients.

关键词： Colonic neoplasm Right colectomy Bowel function D3 lymphadenectomy complete mesocolic excision Quality of life