PDF(Pubmed)
Abstract：
UNASSIGNED: The aim of this study was to systematically review the literature for each surgical step of the minimally invasive right hemicolectomy (MIRH) for non-locally advanced colon cancer, to define the most optimal procedure with the highest level of evidence.
UNASSIGNED: High variability exists in the way MIRH is performed between surgeons and hospitals, which could affect patients\' postoperative and oncological outcomes.
UNASSIGNED: A systematic search using PubMed was performed to first identify systematic reviews and meta-analyses, and if there were none then landmark papers and consensus statements were systematically searched for each key step of MIRH. Systematic reviews were assessed using the AMSTAR-2 tool, and selection was based on highest quality followed by year of publication.
UNASSIGNED: Low (less than 12 mmHg) intra-abdominal pressure (IAP) gives higher mean quality of recovery compared to standard IAP. Complete mesocolic excision (CME) is associated with lowest recurrence and highest 5-year overall survival rates, without worsening short-term outcomes. Routine D3 versus D2 lymphadenectomy showed higher LN yield, but more vascular injuries, and no difference in overall and disease-free survival. Intracorporeal anastomosis is associated with better intra- and postoperative outcomes. The Pfannenstiel incision gives the lowest chance of incisional hernias compared to all other extraction sites.
UNASSIGNED: According to the best available evidence, the most optimal MIRH for colon cancer without clinically involved D3 nodes entails at least low IAP, CME with D2 lymphadenectomy, an intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision.
UNASSIGNED: High variability exists in the way MIRH is performed between surgeons and hospitals, which could affect patients\' postoperative and oncological outcomes.
UNASSIGNED: A systematic search using PubMed was performed to first identify systematic reviews and meta-analyses, and if there were none then landmark papers and consensus statements were systematically searched for each key step of MIRH. Systematic reviews were assessed using the AMSTAR-2 tool, and selection was based on highest quality followed by year of publication.
UNASSIGNED: Low (less than 12 mmHg) intra-abdominal pressure (IAP) gives higher mean quality of recovery compared to standard IAP. Complete mesocolic excision (CME) is associated with lowest recurrence and highest 5-year overall survival rates, without worsening short-term outcomes. Routine D3 versus D2 lymphadenectomy showed higher LN yield, but more vascular injuries, and no difference in overall and disease-free survival. Intracorporeal anastomosis is associated with better intra- and postoperative outcomes. The Pfannenstiel incision gives the lowest chance of incisional hernias compared to all other extraction sites.
UNASSIGNED: According to the best available evidence, the most optimal MIRH for colon cancer without clinically involved D3 nodes entails at least low IAP, CME with D2 lymphadenectomy, an intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision.
摘要：
■本研究的目的是系统回顾非局部晚期结肠癌的微创右半结肠切除术（MIRH）的每个手术步骤的文献，定义具有最高证据水平的最优程序。
■在外科医生和医院之间执行MIRH的方式存在高度可变性，这可能会影响患者的术后和肿瘤预后。
■使用PubMed进行了系统搜索，以首先确定系统综述和荟萃分析，如果没有，则系统搜索MIRH的每个关键步骤的具有里程碑意义的论文和共识声明。使用AMSTAR-2工具评估系统评价，选择是基于最高质量，其次是出版年份。
■与标准IAP相比，低（小于12mmHg）腹内压（IAP）具有更高的平均恢复质量。完整结肠系膜切除术（CME）与最低的复发率和最高的5年总生存率相关。不会恶化短期结果。常规D3与D2淋巴结清扫术显示LN产量较高，但是更多的血管损伤，总体生存率和无病生存率没有差异。体内吻合与更好的术中和术后预后相关。与所有其他拔除部位相比，Pfannenstiel切口发生切口疝的几率最低。
■根据现有的最佳证据，对于没有临床涉及的D3节点的结肠癌，最佳MIRH至少需要低IAP，CME与D2淋巴结清扫术，通过Pfannenstiel切口进行体内吻合和标本提取。
■在外科医生和医院之间执行MIRH的方式存在高度可变性，这可能会影响患者的术后和肿瘤预后。
■使用PubMed进行了系统搜索，以首先确定系统综述和荟萃分析，如果没有，则系统搜索MIRH的每个关键步骤的具有里程碑意义的论文和共识声明。使用AMSTAR-2工具评估系统评价，选择是基于最高质量，其次是出版年份。
■与标准IAP相比，低（小于12mmHg）腹内压（IAP）具有更高的平均恢复质量。完整结肠系膜切除术（CME）与最低的复发率和最高的5年总生存率相关。不会恶化短期结果。常规D3与D2淋巴结清扫术显示LN产量较高，但是更多的血管损伤，总体生存率和无病生存率没有差异。体内吻合与更好的术中和术后预后相关。与所有其他拔除部位相比，Pfannenstiel切口发生切口疝的几率最低。
■根据现有的最佳证据，对于没有临床涉及的D3节点的结肠癌，最佳MIRH至少需要低IAP，CME与D2淋巴结清扫术，通过Pfannenstiel切口进行体内吻合和标本提取。
