ABSTRACT
Introducción: La escisión completa del mesocolon con linfadenectomía D3 (CME-D3) mejora los resultados de los pacientes operados por cáncer del colon. Reconocer adecuadamente la anatomía vascular es fundamental para evitar complicaciones. Objetivo: El objetivo primario fue determinar la prevalencia de las variaciones anatómicas de la arteria mesentérica superior (AMS) y sus ramas en relación a la vena mesentérica superior (VMS). El objetivo secundario fue evaluar la asociación entre las distintas variantes anatómicas y el sexo y la etnia de lo pacientes. Diseño: Estudio de corte transversal. Material y métodos: Se incluyeron 225 pacientes con cáncer del colon derecho diagnosticados entre enero 2017 y diciembre de 2020. Dos radiólogos independientes describieron la anatomía vascular observada en las tomografías computadas. Según la relación de las ramas de la AMS con la VMS, la población fue dividida en 2 grupos y subdividida en 6 (1a-c, 2a-c). Resultados: La arteria ileocólica fue constante, transcurriendo en el 58,7% de los casos por la cara posterior de la VMS. La arteria cólica derecha, presente en el 39,6% de los pacientes, cruzó la VMS por su cara anterior en el 95,5% de los casos. La variante de subgrupo más frecuente fue la 2a seguida por la 1a (36,4 y 24%, respectivamente). No se encontró asociación entre las variantes anatómicas y el sexo u origen étnico. Conclusión: Las variaciones anatómicas de la AMS y sus ramas son frecuentes y no presentan un patrón predominante. No hubo asociación entre las mismas y el sexo u origen étnico en nuestra cohorte. El reconocimiento preoperatorio de estas variantes mediante angiotomografía resulta útil para evitar lesiones vasculares durante la CME-D3. (AU)
Background: Complete mesocolic excision with D3 lymphadenectomy (CME-D3) improves the outcomes of patients operated on for colon cancer. Proper recognition of vascular anatomy is essential to avoid complications. Aim: Primary outcome was to determine the prevalence of anatomical variations of the superior mesenteric artery (SMA) and its branches in relation to the superior mesenteric vein (SMV). Secondary outcome was to evaluate the association between these anatomical variations and sex and ethnicity of the patients. Design: Cross-sectional study. Material and methods: Two hundred twenty-fivepatients with right colon cancer diagnosed between January 2017 and December 2020 were included. Two independent radiologists described the vascular anatomy of computed tomography scans. The population was divided into 2 groups and subdivided into 6 groups (1a-c, 2a-c), according to the relationship of the SMA and its branches with the SMV. Results: The ileocolic artery was constant, crossing the SMV posteriorly in 58.7% of the cases. The right colic artery, present in 39.6% of the patients, crossed the SMV on its anterior aspect in 95.5% of the cases. The most frequent subgroup variant was 2a followed by 1a (36.4 and 24%, respectively). No association was found between anatomical variants and gender or ethnic origin. Conclusions: The anatomical variations of the SMA and its branches are common, with no predominant pattern. There was no association between anatomical variations and gender or ethnic origin in our cohort. Preoperative evaluation of these variations by computed tomography angi-ography is useful to avoid vascular injuries during CME-D3. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colonic Neoplasms/surgery , Colon, Ascending/anatomy & histology , Colon, Ascending/blood supply , Lymph Node Excision , Mesocolon/surgery , Argentina , Tomography, X-Ray Computed/methods , Cross-Sectional Studies , Mesenteric Artery, Superior/anatomy & histology , Sex Distribution , Colectomy/methods , Ethnic Distribution , Anatomic Variation , Mesenteric Veins/anatomy & histologyABSTRACT
The extent of D3 lymphadenectomy for right colon cancer, especially the medial border of central lymph node dissection remains controversial. D3 lymphadenectomy and complete mesocolon excision (CME) are two standard procedures for locally advanced right colon carcinoma. D3 lymphadenectomy determines the medial border according to the distribution of the lymph nodes. The mainstream medial border should be the left side of superior mesenteric vein (SMV) according to the definition of D3, but there are also some reports that regards the left side of superior mesenteric artery (SMA) as the medial border. In contrast, the CME procedure emphasizes the beginning of the colonic mesentery and the left side of SMA should be considered as the medial border. Combined with the anatomical basis, oncological efficacy and technical feasibility of D3 lymph node dissection, we think that it is safe and feasible to take the left side of SMA as the medial boundary of D3 lymph node dissection. This procedure not only takes into account the integrity of mesangial and regional lymph node dissection, but also dissects more distant lymph nodes at risk of metastasis. It has its anatomical basis and potential oncological advantages. However, at present, this technical concept is still in the exploratory stage in practice, and the related clinical evidence is not sufficient.
Subject(s)
Humans , Colectomy/methods , Colonic Neoplasms/surgery , Laparoscopy/methods , Lymph Node Excision/methods , Mesocolon/surgeryABSTRACT
4K laparoscopy brings opportunities and challenges to the development of rectal surgery. 4K laparoscopy can truly provide the structure of abdominal and pelvic fascia, so that surgeons can see more subtle anatomical structure. The clear and real picture under 4K laparoscopic system can reduce visual fatigue of surgeons, which make the operation easier and safer. Radical resection of right colon cancer includes complete mesocolic excision and D 3 lymphadenectomy. Through 4K laparoscopic system, surgeons can easily observe the fascia structure of right mesocolon and its mesenteric bed, distinguish the vascular anatomical relationship at the mesenteric root, which make D 3 lymphadenectomy safer with dissection of lymph nodes completely. The authors comprehensively analyze the related research progress at home and abroad, and systematically elaborate the region of dissection and significance of 4K laparoscopic right hemicolectomy for right colon cancer.
ABSTRACT
D3 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 D3 and CME, especially the similarities and differences between them. However, few articles have been published to discuss these issues specifically. Domestic scholars' understandings about D3 lymphadenectomy and CME for right hemicolectomy are quite different. Two different concepts including "D3/CME" and "D3+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 D3 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 D3 and CME are not complementary.
Subject(s)
Humans , Colectomy/methods , Colonic Neoplasms/surgery , Laparoscopy , Lymph Node Excision/methods , Mesocolon/surgeryABSTRACT
OBJECTIVE: To investigate the feasibility and short-term outcomes of laparoscopic D3 lymphadenectomy along the left of SMA for right colon cancer.METHODS: The clinical data of 134 patients with right colon cancer admitted from June 2015 to March 2017 in Department of Gastrointestinal Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. A total of 57 patients received the laparoscopic D3 lymphadenectomy along the left of SMA and 77 patients received the laparoscopic D3 lymphadenectomy along the left of SMV.RESULTS: There was no statistical difference between the two groups in operation time,intra-operative blood loss,time of liquid intake and post-operative hospital stay,but the SMA group had a longer duration of tube drainage and larger total volume of drainage[(471.4±285.6)mL vs.(352.2±305.7)mL,(7.0±4.9)d vs.(5.7±2.0)d,P=0.02 和 P=0.03]. The SMA group harvested more lymph nodes than the SMV group(26.5±6.7 vs. 21.3±7.8,P<0.0001). However,the SMA group had a higher rate of post-operative complications(28.1% vs. 13.0%, P=0.04).CONCLUSION: Laparoscopic D3 lymphadenectomy along the left side of SMA for right colon cancer is feasible but had a higher rate of post-operative complications.
ABSTRACT
The diagnosis rate of early gastric cancer in China is low,most patients seeing the doctor are already in advanced period.Lymphadenectomy is the key factor affecting the tumor treatment and prognosis.With the depth of the research on tumor immunology,the function of lymph nodes in tumor immunity has been gradually paid more and more attention.The role of lymphadenectomy according to the rule of the lymph nodes metastasis has become the research point of the radical gastrectomy.Gastrectomy with D2 lymphadenectomy is the standard surgical treatment for advanced cancer.Laparoscopic-assisted gastrectomy with D3 lymphadenectomy is also in active exploring.In this article,the application of laparoscopy in advanced gastric cancer of current status,near-term efficacy,long-term outcome and complications are reviewed.
ABSTRACT
Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.
ABSTRACT
Objective To explore the efficacy of laparoscopic right hemicoloectomy with D3 lymph node dissection for right colon cancer based on a no-touch isolation technique.Methods A total of 87 cases was given laparoscopic right hemicoloectomy with D3 lymph node dissection from June 1996 to August 2004.The lymph nodes along the surgical trunk at the root of the superior mesenteric vessels were initially dissected.And the right transverse colon and the ascending colon were isolated.Then a transection of the bowel and an end-to-end enteroanastomosis were conducted extracorporeally. Results The operative time was 120～397 min(mean,212 min).The total number of lymph nodes harvested was 9～91(mean,35),including 0～50 (mean,17.5) paracolic and epicolic lymph nodes,0～20(mean,10.4) intermesenteric nodes,and 0～39(mean,7.5) artery root nodes.The postoperative morbidity rate was 16.1%(14/87),including incision infection in 8 cases(9.2%),ileus in 2 cases(2.3%),perianastomotic inflammation in 2 cases(2.3%),and intraabdominal abscess and fluid collection in 2 cases(2.3%).A total of 84 cases were followed for 12～113 months(mean,45 months).The survival time was over 3 years in 30 cases.Meanwhile a loss to follow-up was recorded in 36 cases.Conclusions Based on the principle of en bloc resection of tumor,a proper approach with clear access,low bleeding,and good visualization is the key to perform laparoscopic right hemicoloectomy.