Clinical Safety Analysis Of Lymph Node Dissection Boundary In Laparoscopic D3 Radical Resection Of Right Colon Cancer

BackgroundRight colon cancer is one of the most common malignant tumors of digestive system in China.In recent years,with the change of people's eating habits,the incidence of right colon cancer has increased year by year,and gradually become an important factor threatening people's daily life.For right colon cancer,surgical treatment is still the first choice.In the choice of surgical methods,in the world,the emergence of laparoscopic technology,compared with the traditional open surgery,greatly improved the quality of life and postoperative recovery speed of patients with right colon cancer,after decades of development,at present,laparoscope-assisted D3 radical resection of right colon cancer has gradually become the standard operation of right colon cancer.However,when laparoscopically assisted D3 radical resection of right colon cancer is performed,there is no unified opinion at home and abroad on the identification of the inner boundary of lymph node dissection.Therefore,if the lymph node dissection boundary of D3 radical resection of right colon cancer can be defined,it has important practical significance for the standard of right colon cancer surgery.ObjectivesThrough the analysis of the related factors of different lymph node dissection boundaries in patients with laparoscopic-assisted D3 radical resection of right colon cancer in our hospital,the clinical safety conclusion of lymph node dissection boundary was obtained,which provides a reference basis for clinicians' operation standards.MethodsA retrospective study was conducted to collect the case data of patients who underwent laparoscopic-assisted D3 radical resection of right colon cancer in the Department of Gastroenterology,affiliated Provincial Hospital of Shandong University from December 01,2014 to March 30,2018.According to strict inclusion and exclusion criteria,patients who meet the criteria were included in this study.According to the boundary of lymph node dissection,the patients were divided into superior mesenteric artery group and superior mesenteric vein group.In the superior mesenteric artery group,the left side of the superior mesenteric artery(superiormesentericartery,SMA)was used as the inner boundary of lymph node dissection for radical resection of right colon cancer,and the left side of the superior mesenteric vein(superiormesentericvein,SMV)was used as the inner boundary of lymph node dissection in the superior mesenteric vein group.By analyzing and comparing the basic information of the two groups of patients and the differences of three related factors during and after operation,we can draw the conclusion of the clinical safety of the two groups of data.There were 17 items of study,including 5 basic information factors of patients,including sex,age,body mass index(bodymassindex,BMI),tumor location,preoperative carcinoembryonic antigen(carcinoembryonicantigen,CEA),2 intraoperative factors,including operation time and intraoperative blood loss.There were 10 postoperative factors,including water intake time,exhaust time,defecation time,chylous leakage,diarrhea,postoperative complications(anastomotic fistula,pulmonary infection,etc.),postoperative hospital stay,hospitalization cost,the number of lymph node dissection,the number of positive lymph nodes.ResultsA total of 83 samples were included in this study,including 31 cases in SMA group and 52 cases in SMV group.There was no significant difference in the basic information and baseline data of sex,age,BMI,tumor location and preoperative CEA between the two groups.There was no significant difference in operation time(192±49min,177±33min,P=0.139)intraoperative blood loss(73±36ml,83±65ml,P=0.429),first exhaust time(4.1±0.85d,3.6±1.4d,P=0.086),first defecation time(5.2±1.2d,5.1±1.5d,P=0.504),first drinking water time(4.7±1.0d,4.4±1.5d,P=0.222),incidence of diarrhea(6.5%,1.9%,P=0.645),incidence of complications(9.7%,7.7%,P=1.0),number of positive lymph nodes(0.7±1.2,0.7± 1.4,P=0.899),postoperative hospital stay(7.7±4.9d,7.4±4.3d,P=0.225)and hospitalization cost(66857±11560 RMB,70040±15780 RMB,P=0.332)between SMA group and SMV group.There were statistical differences in the incidence of chylous leakage(9.7%,0%,P=0.049)and the number of lymph nodes dissected(21 ±4.2,17.5±4.5,P=0.001).ConclusionsLaparoscopic-assisted D3 radical resection of right colon cancer with the left side of SMA as the lymph node dissection boundary is a safe and feasible surgical method.While ensuring the radical resection of the tumor,more lymph nodes can be obtained,but the number of positive lymph nodes will not increase,which makes it meaningful to increase the number of lymph nodes remains to be further verified.The procedure also increased the incidence of postoperative chylous leakage and the potential high incidence of diarrhea,but did not significantly affect the patient's recovery and hospitalization costs.Therefore,when choosing the boundary of lymph node dissection,we should comprehensively consider the patient's physical conditions and lymph node metastasis,and choose individual treatment plan.