Surgical Treatment And Curative Effect Of Complete Mesocolic Excision In Stage ? Colon Cancer

Background:Colorectal cancer is one of the common tumors in China,whoseincidenceisrising year by year,because of the weak ofearly screening for colon cancer and public health awareness,most patients have been found belonging to advanced in our country.Traditional colon cancer surgerydid notpay attention to themethod ofmesocolon,vascular root ligation and dissection,so that the patients,especially in the patients with stage III colon cancer recurrence and metastasis is a few.After Hohenberger first proposed the theory of Complete Mesorectal Excision(CME)for colon cancer,most scholars affirm the meaning in colon caner.But the relevant research of CME is not enough,and the actual operation is still no basis to follow for the majority of doctors,so it is difficult tocontrol the quality of the operation.Objective:Ourretrospective study on two group in different operation of stage III colon cancer patients with pathology and clinical data,compare the difference in surgery operationpathological specimens,short-term effect,serum tumor markers recurrence and metastasis of two groups patients,and explore the surgery principles and clinical efficacy of complete mesocolic excision in stage III colon cancer patients.Methods:There are 85 casesclinical data of stage III colon cancer patients who were treated by the same surgical in Department of Surgical Oncology of The Affiliated Hospital of the Armed Police College during 2012.01 to 2014.12.Depending on the surgical methods the patients were divided into CME group(47 case)and the traditional group(38 cases).Traditional group performed traditional colon cancer surgery,whichincludedbowel resection distance away from the tumor margin at least 8cm,cleaning intestines and peripheral lymph nodes intermediate station,but do not emphasize the separation level of mesentery,the high ligation of main artery and the dissectionoflymph node in central area.In this study,the operator of CME Group stand on the opposite side of the colon cancer,sharp free mesangial and high ligationof feeding vessels.The lymph node in central area of right colon cancer were dissected along with three direction of Henle vascular.The lymph node in central area of right colon cancer were dissected by perspective style around the root of inferior mesenteric artery.we want know whether thedifference of the surgery operationpathological specimens,short-term effect,serum tumor markers recurrence and metastasis have statistically significant.Statistical analyses were made by SPSS 16.0;measurement data of the two groupsof patients were compared by T test or U Mann-Whitney test;Countdata of the two groupsof patients were compared by Chi square test or Fisher exact test,thedifference was considered to have statistical significance when the P<0.05.Results:The number of gross dissected lymph nodes and median positive dissected lymph node in CME group were 20.44±7.26 and 4(2~7),which were significantly higher than those in traditional group[15.11±5.00 and 2(1~5)],P<0.05;operation time[(208.00±32.93)min],intraoperative blood loss[(154.44±68.94)mL] was signifieandy re-duced than traditional group[(223.84±18.80)min,(234.21±96.54)mL](P<0.05);thetime to first bowel movement[(3.93±1.16)day],time to first eat [(5.09±0.93)day]in CME group without significantly difference compare with traditional group[(4.00±1.07)day,(5.61±1.42)day].Thearea of mesentery[165.3(112.7,196.8)?134.4(130.4,187.5)cm2],the distance oftumor to high vascular ligation[13.8(9.8,15.4)?14.6(10.04,16.8)cm],and the shortest distance of bowel to high tie[11.3(8.6,12.8)?10.7(8.4,12.3)cm]in CME group more than the traditional group[116.2(75.6,136.2)?95.3(82.8,135.3)cm2]?[10.7(8.1,14.2)?11.8(8.9,13.8)cm]and[8.2(7.1,11.5)?9.3(7.9,101.4)cm],but the incidence of postoperative complications(17.02%)without significantly difference compare with traditional group(15.79%)(P>0.05).There was 1 case occurred recurrence and metastasis in group of CME(2.13%),and 4 case occurred recurrence and metastasis in group of traditional(10.53%),The difference was statistically significant(P<0.05).Conclusions:1.Complete mesocolon excisioninstage III colon cancerpatientswasbetter than traditional radical operation inlymph node and positive lymph node harvest,operation time,intraoperative bleeding,area of mesentery,the distance oftumor to high vascular ligation,the shortest distance of bowel to high tie,part of pathology indexand postoperative recovery.The stage III colon cancerpatients applicant complete mesocolic resection is superior to the traditional operation method.2.In the operating process of complete mesocolon excision,the operator standing on the opposite side of the colon cancer pull tissue to keep the tensionwith left hand and separat the mesocolonwiththe right hand.In this way we can ensure the integrity of the Toldt fascia.It increase the convenience of operation and have strongmaneuverability.3.The lymph nodes in central area of right and left colon cancer were dissected by the way ofthree direction of Henle vascularandperspective style around the root of inferior mesenteric artery,which can increase the number of lymph node dissection,reducing the residual tumor and reduce postoperative recurrence rate.