| Objective: Based on single center data,the scope of laparoscopic right colon cancer lymph node dissection and its metastatic pattern were investigated,and the safety and complications of laparoscopic and open surgery for D3 lymph node dissection were analyzed.Methods:A retrospective cross-sectional study was conducted to collect the clinicopathological data of 130 patients who received laparoscopic radical resection of right colon cancer and 80 patients who received open radical resection of right colon cancer in the Department of Gastrointestinal Surgery of the Second Affiliated Hospital of Fujian Medical University from December 2014 to December 2017.All patients received D3 radical resection.Outcome indicators :(1)the relationship between tumor site and lymph node metastasis;(2)the relationship between T stage and lymph node metastasis(3)the safety of surgery;(4)Postoperative recovery;(5)Complications;(6)Follow-up.Outpatient or telephone follow-up was used to understand the tumor recurrence and survival of the patients.The cut-off date for follow-up was December 1,2019.SPSS 25.0 was used as statistical software.The measurement data of normal distribution was expressed as Mean±s,and t test was used for comparison between groups.Enumeration data were expressed as absolute number or percentage,and comparison between groups was performed by X2 test.Rank sum test was used for grade data.Cox proportional risk model was used to analyze the effects of univariate and multivariate factors on the prognosis of patients with lymph node metastasis.Kaplan-Meier method was used for survival analysis.Results:(1)Relationship between tumor site and lymph node metastasis: among cecal cancer patients,the most common occurrence of metastasis was in IC1(40.3),of which6.1% was in MC2 R,and RC3,MC1,MC2 L and MC3 had no metastasis.In ascending colon cancer patients,IC1 was the most common metastatic site(24.0%),followed by RC1(21.8%).No MC3 transfer.Among patients with hepatic convoluted tumors,22.2%had metastasis to RC1 and 22.8% to MC1,and metastasis was also observed in all examined lymph nodes.In a patient with liver curvature carcinoma,MC2 R,MC3 IC1,IC2,and IC3 metastases were found to be non-metastatic to the RC node.MC1 was the most common metastatic region in patients with transverse colon(34.6%),with 22.9%,28.6%,and 14.3% metastatic to MC2 R,MC2L,and MC3 regions,respectively,and11.4%,7.7%,and 7.6% metastatic to RC1,RC2,and RC3,but not to IC1,IC2,and IC3.(2)Relationship between T staging and lymph node metastasis: Among 210 patients,the incidence of metastasis to intermediate lymph nodes was 13.3%(28/210),and the majority of patients with PT3 and PT4 cancers were diagnosed.The incidence of metastasis to the main lymph node was 3.8%(8/210).No matter the location of the tumor,the proportion of positive major lymph nodes increased steadily with the increase of the depth of invasion.However,no major lymph node metastasis occurred in patients with PT1 or PT2 carcinoma.(3)Operation safety: in the laparoscopic group,the operative time,intraoperative blood loss and the number of dissected lymph nodes were(111.52±15.21)min,(63.33±18.62)ml and(32.52±6.28),respectively.The above indexes in open group were(105.34±14.91)min,(65.21±19.10)m L and(29.74±5.04)pieces,respectively.There were statistically significant differences in the operative time and number of lymph nodes dissection between the two groups(P < 0.05),while there was no statistically significant difference in the amount of intraoperative blood loss between the two groups(P > 0.05).(4)Postoperative recovery:In the laparoscopic group,the postoperative anal exhaust time,feeding time,activity time out of bed and postoperative hospitalization time were(2.1±1.0)d,(3.9±2.4)d,(4.3±2.7)d,(10.5±2.6)d,respectively.The above indexes in the open group were(3.1±1.5)d,(4.8±2.8)d,(5.2±2.4)d and(12.6±3.3)d,respectively,and the differences between the two groups were statistically significant.(5)Complications: In the 130 laparoscopic group,10(8.5%)cases had chylous leakage after surgery,and the difference was 3(3.8%)statistically significant compared with that in the open group(P < 0.05).There were no statistically significant differences in postoperative intestinal obstruction,anastomotic bleeding,anastomotic leakage and incision infection between the two groups.(2)Follow-up:A total of 210 patients were included in this study,including 130 patients in the endoscopic group and 80 patients in the open group.The follow-up time was8-63 months,with a median follow-up time of 29 months,and the deadline of follow-up was January 2019.In the laparoscopic group,the follow-up time was 8-62 months,and the median follow-up time was 27 months.There were 2 cases of local recurrence,5 cases of liver metastasis and 4 cases of lung metastasis all survived with tumor.The follow-up time of the open group was 7-59 months,and the median follow-up time was 25 months.There was 1 case of local recurrence,3 cases of liver metastasis and 2 cases of lung metastasis,and all survived with tumor.The 3-year DFS(disease-free Survival)of the laparoscopic group and the open group were 83.4% and82.7%,respectively,and the difference was not statistically significant(P< 0.05).Conclusion: D3 radical resection of the right colon cancer can complete dissection of all the lymph nodes that may have local metastases,and can obtain satisfactory clinical efficacy.But the tumor site is different,its scope of lymph node metastasis also have differences,the cleaning scope of the lymph nodes should be choose according to tumor location,and D3 lymph node metastatic rate is closely related with tumor infiltration depth,deeply understand the law of right half colon cancer lymph node metastasis and scope,will help to improve the effectiveness and safety of tumor resection.At the same time,laparoscopic D3 radical resection of right colon cancer is a safe and effective surgical method,whose clinical efficacy is not inferior to that of open surgery,and the postoperative recovery is faster. |
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