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  • 1 Bács-Kiskun Megyei Kórház, 6000 Kecskemét, Nyíri u 38.
  • 2 Bács-Kiskun Megyei Kórház, Kecskemét
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Absztrakt:

Bevezetés: Hohenberger 2009-ben a totális mezorectális excízió (TME) elvét átültette a kolonsebészetbe, és az új műtétet komplett mezokólikus excíziónak nevezte el (CME). A CME lényege az érintett kolonszakasz eltávolítása a viszcerális peritoneum sérülése nélkül az ellátó erek centrális lekötésével a viszcerális és parietális fascia közötti embrionális rétegben preparálva. Ez nyitottan és laparoszkóppal is végezhető. Célkitűzés: Válogatás nélküli beteganyagon meggyőződni arról, hogy elvégezhető-e a CME laparoszkóppal hasonló eredménnyel, mint nyílt műtét során. Eredmények: 2016. 09. 01. és 2019. 06. 30. között 156 műtét történt jobb oldali malignus vastagbéldaganat miatt. 143 esetben végeztünk kuratív reszekciót, 63 férfi és 80 nőbetegnél. Az átlagéletkor férfiaknál 71,5 évnek, míg nőknél 73 évnek bizonyult. 84 műtétet laparoszkóppal, 59 műtétet nyitottan végeztünk. Konvencionális műtét 56 esetben, míg CME 87 esetben történt. Az átlagos kolonhossz konvencionális műtétnél 22,34 cm, míg CME esetén 24,97 cm volt (p = 0,18). A nyirokcsomók átlagos száma a hagyományos műtétnél 15,4, míg CME esetén 16,9 volt (p = 0,24). Az átlagos műtéti idő nyitott műtétnél 111, míg laparoszkópos műtétnél 136 perc volt (p = 0,0014), az átlagos ápolási idő pedig a szövődményes esetek nélkül a nyitott csoportban 7,47, míg a laparoszkópos csoportban 5,65 napnak bizonyult (p = 0,0004). Megbeszélés: A korai eredmények alapján az mondható, hogy laparoszkóppal is elvégezhető a műtét hasonló eredményekkel, valamivel rövidebb ápolási idővel.

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  • 1

    Ferlay J, Soerjomataram I, Dikshit R et al.: Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136(5): E359–86.

  • 2

    Heald RJ, Ryell RD: Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 327: 1479–1482.

  • 3

    Martling AL, Holm T, Rutquist LE et al.: Effect of a surgical training program on outcome of rectal cancer outcome in Stockholm. Br J Surg 2005; 92: 225–229.

  • 4

    Kapiteijn E, Putter H, Van de Velde CJ: Cooperative investigators of the Dutch Colorectal Cancer Group. Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 2002; 89: 1142–1149.

  • 5

    Wibe A, Moller B, Norstein J et al.: Norwegian Rectal Cancer Group: A national strategic change in treatment policy for rectal cancer implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002; 45: 857–866.

  • 6

    Iversen LH, Norgaard M, Jepsen P et al.: Trends in colorectal cancer survival in 21northern Denmark: 1985-2004. Colorectal Dis 2007; 9: 210–217.

  • 7

    Hohenberger W, Weber K, Matzel K et al.: Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis 2009; 11: 354–364.

  • 8

    Emmanuel E, Haji A: Complete mesocolic excision and extended (D3) lymphadenectomy for colonic cancer: is it worth that extra effort? A review of the literature. Int J Colorectal Dis 2016; 31: 797–804.

  • 9

    Storli KE, Sondenaa K, Furnes B et al.: Short term results of complete (D3) vs standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol 2014; 18: 557–564.

  • 10

    Bertelsen CA, Neuenschwander AU, Jansen JE et al.: Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a population-based study. Lancet Oncol 2015; 16: 161–168.

  • 11

    Siani LM, Plica C: Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: Long-term oncological outcome between mesocolic and non-mesocolic planes of surgery. Scand J Surg 2015; 104(4): 219–226.

  • 12

    Zurleni T, Cassiano A, Gjoni E et al.: Surgical and oncological outcomes after complete mesocolic excision in right-sided colon cancer compared with conventional surgery: a retrospective, single-institution study. Int J Colorectal Dis 2017; https://doi.org/s00384-017-2917-2

  • 13

    Yamamoto S, Inomata M, Katayama H et al.: Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 2014; 260(1): 23–30.

  • 14

    Perdawid SK, Hemmingsen L, Bocsby S: Survival after elective surgery for colonic cancer in Denmark. Colorectal Dis. 2012; 14: 832–827.

  • 15

    Enker WE, Laffer UT, Block GE: Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 1979; 190: 350–360.

  • 16

    Bokey EL, Chapuis PH, Dent OF et al.: Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon Rectum 2003; 46(7): 860–866.

  • 17

    West NP, Morris EJA, Rotimi O et al.: Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 2008; 9(9): 857–865.

  • 18

    Gao Z, Ye Y, Zhang W et al.: An anatomical, histopathological and molecular biological function study of the fascias posterior to the interperitoneal colon and associated mesocolon: their relevance to colonic surgery. J Anat 2013; 223(2): 123–132.

  • 19

    Compton CC, Fielding LP, Burgart LJ et al.: Prognostic factors in colorectal cancers. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000;124: 979–994.

  • 20

    Nelson H, Petrelli N, Carlin A et al.: Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001; 93(8): 583–589.

  • 21

    Cserni G, Vinh-Hung V, Burzykowski T: Is there a minimum number of lymph nodes that should be histologically assessed for a reliable nodal staging of T3N0M0 colorectal carcinomas? J Surg Oncol 2002; 81: 63–69.

  • 22

    Le Voyer TE, Sigurdson ER, Hanlon AL et al.: Colon cancer survival is associated with increasing number of lymph nodes analyzed. J Clin Oncol 2003; 21: 2912–2919.

  • 23

    Chen SL, Bilchik AJ: More extensive nodal dissection improves survival for stages I to III of colon cancer: population-based study. Ann Surg 2006; 244(4): 602–610.

  • 24

    Tsai H-L, Lu C-H, Hsieh J-S et al.: The prognostic significance of total lymph node harvest in patients with T2-4N0M0 colorectal cancer. J Gastrointest Surg 2007; 11: 660–665.

  • 25

    Weitz J, Koch M, Debus J et al.: Colorectal cancer. Lancet 2005; 365: 153–165.

  • 26

    Faerden AE, Sjo OH, Bukholm IR et al.: Lymph node micrometastases and isolated tumor cells influence survival in stage I and II colon cancer. Dis Colon Rectum 2011; 54: 200–206.

  • 27

    Bilchic A, Nissan A, Wainberg Z et al.: Surgical quality and nodal ultrastaging is associated with long-term disease-free survival in early colorectal cancer. Ann Surg 2010; 252(3): 467–476.

  • 28

    Merrie AE, Phillips LV, Yun K et al.: Skip metastases in colon cancer: assessment by lymph node mapping using molecular detection. Surgery 2001; 12: 684–691.

  • 29

    Bertelsen CA, Kirkegaard-Klitbo A, Nielsen M et al.: Pattern of colon cancer lymph node metastases in patients undergoing central mesocolic lymph node excision: a systematic review. Dis Colon Rectum 2016; 59: 1209–1221.

  • 30

    West NP, Kenedy RH, Magro T et al.: Morphometric analysis and lymph node yield in laparoscopic complete mesocolic excision performed by supervised trainees. Br J Surg 2014; 101:1460–1467.

  • 31

    Nakajima K, Inomata M, Akagi T et al.: Quality control by photo documentation for evaluation of laparoscopic and open colectomy with D3 resection for stage II/III colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Japan J Clin Oncol 2014; 44(9): 799–806.

  • 32

    West NP, Sutton KM, Ingeholm P et al.: Improving the quality of colon cancer surgery through a surgical education program. Dis Colon Rectum 2010; 53(12): 1594–1603.

  • 33

    Munkedal DL, West NP, Iversen LH et al.: Implementation of complete mesocolic excision at a university hospital in Denmark: an audit of consecutive, prospectively collected colon cancer specimens. Eur J Surg Oncol 2014; 40(11): 1491–1501.

  • 34

    Storli KE, Lygre BK, Iversen BL et al.: Laparoscopic complete mesocolic excision for colonic cancer in the last decade: Five-year survival in a single centre. World J Gastrointest Surg 2017; 9(11): 215–223.

  • 35

    Bertelsen CA: Complete Mesocolic Excision. Dan Med J 2017; 64(2): B5334