Extended hemicolectomy

  • 文章类型: Journal Article
    目的:结肠癌的发病率急剧增加。此外,该数据库缺乏对中横结结肠癌手术结局进行分析的综述,近期有几项有争议的研究.我们旨在比较扩大半结肠切除术与横结肠切除术治疗中横结肠癌的结果。
    方法:PubMed,范围,从开始到2022年12月1日,搜索了WebofScience和CochraneLibrary的合格研究,并进行了系统评价和荟萃分析以检测。
    结果:根据资格标准,我们的研究包括8项研究(2237例患者)。纳入研究的汇总结果显示,5年OS没有差异,两种手术类型之间的3年DFS和5年DFS(5年OS,RR=1.15,95%CI0.94-1.39,P=0.17),(3年操作系统,RR=0.96,95%CI0.88-1.06,P=0.42)和(5年DFS,RR=1.21,95%CI0.91-1.62,P=0.20)。除此之外,两组的复发率和并发症发生率相似(复发率,RR=1.08,95%CI0.62-1.89,P=0.79)和(并发症,RR=1.07,95%CI0.74-1.54,P=0.72)。然而,在扩大半结肠切除术的情况下,LN收获的数量和手术时间更多。
    结论:尽管收获的LN较少,横结肠切除术与扩大半结肠切除术治疗中横结肠结肠癌的肿瘤学结果相似.除此之外,两种手术的并发症发生率无显著差异。
    OBJECTIVE: The incidence of cancer colon has increased dramatically. In addition, the database lacks a review to analyze the outcomes of surgeries for mid-transverse colon cancer with several recent controversial studies. We aimed to compare the outcomes of extended hemicolectomy versus transverse colectomy for mid-transverse colon cancer.
    METHODS: PubMed, Scopes, Web of Science and Cochrane Library were searched for eligible studies from inception to 1 December 2022 and a systematic review and meta-analysis were done to detect.
    RESULTS: According to eligibility criteria, 8 studies (2237 patients) were included in our study. The pooled results of the included studies showed no difference in the 5-year OS, 3-year DFS and 5-year DFS between the two types of surgery (5-year OS, RR = 1.15, 95% CI 0.94-1.39, P = 0.17), (3-year OS, RR = 0.96, 95% CI 0.88-1.06, P = 0.42) and (5-year DFS, RR = 1.21, 95% CI 0.91-1.62, P = 0.20). In addition to that, the recurrence rate and the incidence of complications were similar in the two groups (Recurrence rate, RR = 1.08, 95% CI 0.62-1.89, P = 0.79) and (Complications, RR = 1.07, 95% CI 0.74-1.54, P = 0.72). However, the number of LN harvest and the time of the operation were more in case of extended hemicolectomy.
    CONCLUSIONS: Despite harvesting less LN, transverse colectomy has similar oncological outcomes to extended hemicolectomy for mid-transverse colon cancer. In addition to that, there was no significant difference in the incidence of complications between the two surgeries.
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  • 文章类型: Case Reports
    肠梗阻是肠内容物从排出到邻近的远端肠或外部环境的机械或功能性阻滞。盲肠扭转是回肠远端的扭曲,肠系膜上的盲肠和升结肠。横结肠扭转是大肠梗阻的另一种罕见原因,甚至比盲肠扭转更不普遍。结肠减压造口切除术是盲肠或横结肠扭转的广泛干预措施。
    方法:一名45岁的男性患者就诊于我们中心,其粪便和排气未能通过5天。他还有腹痛,腹胀和摄入物质的呕吐。除轻度心动过速外,生命体征正常。他腹部扩张,不柔软,过度活跃的肠鸣音和鼓室高敲击。然而,没有腹部或直肠肿块积液的迹象。腹部X线平片显示大肠环扩张,有多个空气液水平。剖腹探查术显示盲肠和横结肠同时在肠系膜上顺时针扭转270度。
    结论:机械性肠梗阻是发达国家和发展中国家手术入院的主要原因。解剖和先天性因素在横结肠和盲肠扭转中起重要作用。在盲肠和横结肠扭转的情况下,内窥镜减压的可能性较小,不建议使用。
    结论:同时发生盲肠和横结肠扭转是一种极其罕见的情况,迄今为止在文献史上没有报道。治疗包括扩大的右半结肠切除术,近端转移和远端粘液瘘。
    UNASSIGNED: Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. Cecal volvulus is the twisting of distal ileum, cecum and ascending colon on their mesentery. Transverse colon volvulus is another rare cause of large bowel obstruction even less prevalent than cecal volvulus. Colectomy with decompression stoma is the widely practice of intervention in cecal or transverse colon volvulus.
    METHODS: A 45 years-old male patient presented to our center with failure to pass feces and flatus of 5 days duration. He also had crampy abdominal pain, abdominal distention and vomiting of ingested matter. Vital signs were normal except mild tachycardia. He had distended non-tender abdomen, hyperactive bowel sound and hyper-tympanic percussion. However, there was no sign of fluid collection of abdominal or rectal mass. Plain abdominal X-ray showed distended large bowel loops with multiple air fluid levels. Exploratory laparotomy revealed simultaneous cecal and transverse colon clockwise volvulus 270 degrees on their mesentery.
    CONCLUSIONS: Mechanical bowel obstruction is major cause of surgical admission in both developed and developing countries. Anatomic and congenital factors play significant role in both transverse colon and cecal volvulus. Endoscopic decompression in the case of cecal and transverse colon volvulus is less probable and not recommended.
    CONCLUSIONS: Simultaneous cecal and transverse colon volvulus is an extremely rare occasion where there is no report in the history of literatures to date. Management involves extended right hemicolectomy with proximal diversion and distal mucus fistula.
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  • 文章类型: Comparative Study
    Transverse colon cancer (TCC) is poorly studied, and TCC cases are often excluded from large prospective randomized trials because of their complexity and their potentially high complication rate. The best surgical approach for TCC has yet to be established. The aim of this large retrospective multicenter Italian series is to investigate the advantages and disadvantages of both hemicolectomy and transverse colectomy in order to identify the best surgical approach.
    This was a retrospective cohort study of patients with mid-transverse colon cancer treated with a segmental colon resection or an extended hemicolectomy (right or left) between 2006 and 2016 in 28 high-volume (more than 70 procedures/year) Italian referral centers for colorectal surgery.
    The study included 1529 patients, 388 of whom underwent a segmental resection while 1141 underwent an extended resection. A higher number of complications has been reported in the segmental group than in the extended group (30.1% versus 23.6%; p 0.010). In 42 cases the main complication was the anastomotic leak (4.4% versus 2.2%; p 0.020). Recovery outcomes also showed statistical differences: time to first flatus (p 0.014), time to first mobilization (p 0.040), and overall hospital stay (p < 0.001) were significantly shorter in the extended group. Even if overall survival were similar between the groups (95.1% versus 97%; p 0.384), 3-year disease-free survival worsened after segmental resection (78.1% versus 86.2%; p 0.001).
    According to our results, an extended right colon resection for TCC seems to be surgically safer and more oncologically valid.
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