Observational Study Of Subpyloric Lymph Nodes Dissection For Laparoscopic Radical Right Hemicolectomy

BackgroundColon cancer is one of the most common gastrointestinal malignancies in the world,and is the third most common cancer worldwide.Among them,right hemi-colon cancer accounts for a relatively low proportion of colon cancer(1.4-6.0%),and surgical resection is still the main treatment modality.In recent years,laparoscopic technology has developed rapidly,and the application of laparoscopic technology has become more and more widespread in radical right hemicolectomy for colon cancer.Compared with traditional open surgery,laparoscopy has the advantages of less trauma,higher safety and better prognosis,and it is even more effective in lymph node dissection.At present,there are mainly two different options for radical colon cancer surgery:one is D3 radical colon cancer surgery proposed by Japanese scholars,and the other is complete mesocolic excision(CME)proposed by European scholars.Both are controversial on the issue of whether subpyloric lymph nodes need to be routinely cleared for right colon cancer.Since May 2020,subpyloric lymph node dissection for laparoscopic radical right hemicolectomy has been progressively performed at Shandong Provincial Hospital.The surgical approach and the scope of lymph node dissection for progressive ascending colon cancer,as well as the need for a more aggressive treatment approach such as subpyloric lymph node dissection,are important clinical topics.ObjectivesEvaluation of subpyloric lymph node dissection for laparoscopic radical right hemicolectomy in patients with right hemi-colon cancer.MethodsA retrospective study was conducted to screen and select medical records of patients who underwent laparoscopic radical right hemicolectomy for right colon cancer in the gastrointestinal surgery ward from May 2020 to March 2021 based on inclusion and exclusion criteria through the medical record system of Shandong Provincial Hospital.Then,based on whether subpyloric lymph node dissection was performed intraoperatively,two groups were divided,with 31 cases in the dissected group and 55 cases in the non-dissected group.The study indicators were divided into three categories:preoperative,intraoperative and postoperative,totaling 17,including preoperative indicators:patient age,gender,BMI,general status(albumin,glucose,CRP).Intraoperative indicators:operation time,bleeding volume,subpyloric lymph node dissection.Postoperative indicators:pathological type and number of positive lymph nodes,albumin,CRP,leukocytes,gastrointestinal function recovery days,hospitalization days and complications.SPSS 22.0 was used to analyze and process the above study data.The measurement data were tested by independent sample t-test and rank sum test according to normal distribution and chi-square test respectively,and the count data were analyzed by Pearson χ 2 test,continuity correction test or Fisher exact probability test according to the actual frequency size,with P<0.05 as the significance index.ResultsThe two groups were compared:there was a statistically significant difference in the operative time between the two groups(P=0.027),and the number of lymph nodes cleared was greater in the cleared group than in the uncleared group(P=0.006).There was no statistical significance in the comparison of data on the amount of bleeding,the occurrence of postoperative complications,the postoperative inflammatory response(elevated white blood cells,elevated C-reactive protein),the postoperative gastrointestinal recovery period,and hospitalization days(P>0.05).ConclusionsIn laparoscopic radical colon cancer surgery,subpyloric lymph node dissectionincreases the operative time,and subpyloric lymph node dissection does not lead to increased bleeding,increased occurrence of complications,increased inflammatory response,or prolonged gastrointestinal recovery date and hospital days.