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1.
Magy Seb ; 73(1): 23-28, 2020 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-32172577

RESUMO

Introduction: In 2009, Hohenberger translated the concept of total mesorectal excision to colon cancer surgery and he named it complete mesocolic excision (CME). The principle of CME is based on wide mesenteric excision in the embriologic plane to remove mesenteric lymph nodes, central vascular ligation without damage of the peritoneal layer. CME can be performed by laparoscopic and open methods. Aim: To make sure that we are capable of performing right laparoscopic hemicolectomy with similar results to the open method. Results: A cohort of 156 consecutive patients were operated on with malignant right-sided colon tumours from 01.09.2016 to 30.06.2019. 143 curative resections were performed in 63 men and 80 women. The average age of men and women were 71.5 and 72.75 years, respectively. 84 laparoscopic and 59 open operations were performed. 84 patients underwent CME surgery and 56 conventional resections. The average length of the specimen was 22.34 cm in the conventional and 24.97 cm in CME surgery (p = 0.18) and the average lymph node number were 15.4 and 16.9, respectively (p = 0.24). The average duration of the operation was 111 minutes for the conventional and 136 minutes for the CME group (p = 0.0014), while the average length of stay were 7.47 days and 5.65 days (p = 0.0004) respectively for the cases without complications. Conclusion: We are yet in the learning period, but based on the early results, it might be concluded that the operation can be performed by laparoscopic methods as well with similar results to the open operation but with shorter length of stay.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Mesocolo/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Neoplasias do Colo/patologia , Feminino , Humanos , Ligadura , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 51-55, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958931

RESUMO

Objective: To investigate the Clavien-Dindo (CD) classification of complications after complete mesocolic excision (CME) in laparoscopic radical resection of right-sided hemicolon cancer and its influencing factors. Methods: A retrospective case-control study was performed. Inclusion criteria: (1) the adenocarcinoma located at colon from cecum to hepatic flexure; (2) laparoscopic right hemicolectomy with CME was completed. Exclusion criteria: (1) patients had severe organ dysfunction before operation; (2) tumor invaded adjacent organs or developed distant organ metastasis; (3) emergency surgery; (4) failure of laparoscopic surgery, and conversion to laparotomy; (5) without complete clinical data. Finally, clinical data of 141 patients in our hospital form March 2015 to February 2019 were retrospectively analyzed. CD grading standard was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyse were used to analyze the factors that might affect the complications. Survival analysis was conducted by grouping the indicators with statistically significant difference in multivariate analysis. Kaplan-Meier method was used to draw the survival curve and log-rank test was used to analyze the difference. Results: Of the 141 patients, 89 were male and 52 were female with mean age of (61.8±11.0) years. All the operations completed successfully. A total of 37 postoperative complications were developed in 26 (18.4%) patients had postoperative 37 cases of complications, mainly including 7 delayed incision healing, 6 diarrhea, and 5 respiratory dysfunction. According to CD classification standard, grade I, II, and IV a complication rates were 40.5% (15/37), 56.8% (21/37), and 2.7% (1/37) respectively. Univariate analysis showed that age ≥ 65 years (χ(2)=4.338, P=0.037), BMI ≥ 28 kg/m(2) (χ(2)=5.971, P=0.015), and preoperative hemoglobin < 100 g/L (χ(2)=3.985, P=0.046) were risk factors of postoperative complications. Multivariate analysis testified that age ≥ 65 years (OR=7.991, 95%CI: 2.203 to 28.983, P=0.002) and body mass index (BMI) ≥ 28 kg/m(2) (OR=4.231, 95%CI: 1.034 to 17.322, P=0.045) were independent risk factors for complications after laparoscopic CME surgery for right-sided hemicolon cancer. All the patients were followed up for median time of 24 (1-48) months. The log-rank test showed that there were no significant differences in the cumulative survival rate between patients of age < 65 years and age ≥ 65 years (χ(2)=0.986, P=0.321), and between those with BMI < 28 kg/m(2) and BMI ≥ 28 kg/m(2) (χ(2)=0.370, P=0.543). Conclusions: The main complications after CME in laparoscopic radical resection of right hemicolon cancer are CD grade I and II. Elderly and obesity are independent risk factor for postoperative complications. Before the operation, reasonable preventive measures should be taken for the elderly and the obese in order to reduce postoperative complications.


Assuntos
Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Mesocolo/cirurgia , Fatores Etários , Idoso , Colectomia/métodos , Neoplasias do Colo/complicações , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Resultado do Tratamento
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1105-1109, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874523

RESUMO

Colon cancer is one of the most common malignancies of the alimentary tract, and one main metastatic route is lymph node metastasis. Thorough dissections of regional lymph nodes is one of the core surgical treatment of right colon cancer. D3 lymphadenectomy and complete mesocolic excision (CME) are generally accepted surgical methods for right colon cancer, which can improve the standardization of surgery, improve the quality of tumor resection, and provide more lymph nodes dissectal. Colon cancer of hepatic flexure is likely to have metastasis of the infrapyloric lymph nodes (No.206), which are not regional lymph nodes. Lymph node dissection of No.206 group belongs to extended right hemicolectomy, which involves many vascular variations and complicated peripheral anatomical structure. The theory of fascial surgery provides surgeons with anatomic basis and a clear understanding of the anatomical structure of the infrapyloric region, which is an important theoretical basis for the thorough dissection of lymph nodes in No.206 group, and can completely remove the mass, regional lymph nodes and adipose connective tissue, so as to achieve the goal of non-bleeding surgery. Lymph nodes in No.206 group were dissected, not just the visible lymph nodes, but the entire lymph nodes and lymphatic vessels in the region, including adipose tissue. Extended right hemicolectomy requires higher surgical techniques. The survival benefits of extended right hemicolectomy are not supported by high-level evidence. It is still controversial whether the infrapyloric lymph node dissection should become routine for colon cancer of hepatic flexure. In this article, the metastasis and dissection of infrapyloric lymph node in colon cancer of hepatic flexure is elucidated.


Assuntos
Colo Ascendente/patologia , Neoplasias do Colo/patologia , Excisão de Linfonodo/métodos , Linfonodos/patologia , Mesocolo/patologia , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Humanos , Linfonodos/cirurgia , Metástase Linfática , Mesocolo/cirurgia
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 920-925, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630487

RESUMO

The theory of membrane surgery actually holds the same concepts as that of traditional cancer surgery, which believes that tumor spread is regarded as an isotropic process but the tumor is confined by the block of the membrane. Therefore, the radical resection can be achieved by complete mesentery excision along the membrane plane. The surgical practice derived from these conceptions is extended excision and lays emphasis on tumor-free margins. But the theory is controversial in the view of the existence of mesorectal fascial envelope and the feasibility of complete excision of mesorectum along the "holy plane". Based on ontogenetic anatomy, the compartment theory suggeststhat tumor spread is not isotropic, and it is locally confined within the ontogenetic compartment derived from a common primordium for a relatively long phase during their natural course. Local tumor is suppressed by the boundary instead of fascia. The anatomical territory developing from each anlage primordium may be separated morphologically. Consequently, ontogenetic compartment theory states that optimal local control of cancer is achieved by whole compartment resection, irrespective of margin width. The compartment model of tumor spread provides explanations for total mesorectal excision (TME) which excises the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles for surgical tumor treatment, namely the resection of the tumor bearing compartment rather than target organ.


Assuntos
Mesentério/patologia , Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Colectomia/métodos , Colectomia/normas , Fáscia/patologia , Humanos , Margens de Excisão , Mesocolo/patologia , Mesocolo/cirurgia , Invasividade Neoplásica , Metástase Neoplásica , Protectomia/normas , Reto/anatomia & histologia , Reto/patologia
6.
Gan To Kagaku Ryoho ; 46(10): 1659-1661, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631167

RESUMO

A 52-year-old man whose fecal occult blood test was positive was found to have type 2 sigmoid colon cancer by colonoscopy. On enhanced barium enema study, the cecum was in the pelvis, and the ascending colon was running medially in the abdomen. Enhanced CT scan of the abdomen revealed rotation of the superior mesenteric vein(SMV). We diagnosed the case as sigmoid colon cancer(cT3N0M0, StageⅡA)with non rotation-type intestinal malrotation, and performed laparoscopic surgery. We confirmed the small intestine to be located on the right side of the abdomen, the cecum to be located in the pelvis, and the ascending colon to be running medially in the abdomen. The ascending mesocolon was adherent to the right of the sigmoid mesocolon. Following dissections of the ascending mesocolon from the sigmoid mesocolon, we performed surgery via the inside approach as usual. We dissected the root of the inferior mesenteric artery(IMA), and the operation was completed. In laparoscopic surgery for colorectal cancer with intestinal malrotation, there are some reports that it could be performed safely if attention is paid to adhesion of the mesenteries and vascular variation in the course of preoperative imaging diagnosis. We report a case of laparoscopic surgery that could be safely performed for sigmoid colon cancer with non rotation-type intestinal malrotation.


Assuntos
Anormalidades do Sistema Digestório , Volvo Intestinal , Laparoscopia , Mesocolo , Neoplasias do Colo Sigmoide , Colo Sigmoide , Humanos , Masculino , Mesocolo/cirurgia , Pessoa de Meia-Idade , Neoplasias do Colo Sigmoide/cirurgia
8.
J. coloproctol. (Rio J., Impr.) ; 39(3): 274-278, June-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040326

RESUMO

ABSTRACT Complete mesocolon excision is an alternative in the treatment of neoplasias. The open technique was initially described for the procedure; however, it has some limitations. In this scenario, videolaparoscopic surgery is a minimally invasive alternative; however, its use in complete mesocolon excision is controversial. This study aimed to evaluate the results of videolaparoscopic complete mesocolon excision. A systematic review of the literature was performed for this study. Nine articles were selected, comprising 860 patients. The surgical results demonstrate the quality of the videolaparoscopic technique, which presents low morbidity and mortality and high survival rates after five years. Videolaparoscopy is a safe and effective method for complete mesocolon excision.


RESUMO A excisão completa do mesocolon constitui-se como alternativa para o tratamento de neoplasias. A técnica aberta foi descrita inicialmente para a realização do procedimento, no entanto apresenta algumas limitações. Nesse cenário a cirurgia por videolaparoscopia apresenta-se como alternativa minimamente invasiva, no entanto sua empregabilidade para a excisão completa do mesocolon é motivo de controvérsia. O objetivo deste trabalho é estudar os resultados oriundos da cirurgia por videolaparoscopia aplicada à excisão completa do mesocolon. A revisão sistemática da literatura foi utilizada para a realização deste estudo. Nove artigos científicos foram selecionados, compreendendo 860 pacientes. Os resultados cirúrgicos demonstram a qualidade da técnica por videolaparoscopia, que apresenta baixa morbidade e mortalidade e com altas taxas de sobrevivência após cinco anos. A videolaparoscopia aplicada à excisão completa do mesocolon apresenta qualidade que possibilita a realização da excisão completa do mesocolon de forma segura e eficaz.


Assuntos
Laparoscopia , Mesocolo/cirurgia , Neoplasias Peritoneais
9.
N Z Med J ; 132(1501): 41-47, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31465326

RESUMO

BACKGROUND: Laparoscopic appendicectomy is one of the most commonly performed abdominal surgical procedures in children, with many different techniques used to isolate and control the appendiceal artery. Previous studies have looked into the utility of different methods of mesoappendix dissection, however these have been predominantly small-scale studies performed on adults. AIM: The current study aimed to assess the safety and efficacy of 'hook' diathermy as a sole means of mesoappendix dissection in children under 15 years of age undergoing laparoscopic appendicectomy. METHODS: Retrospective review of hospital database and electronic clinical notes of children aged under 15 who underwent laparoscopic appendicectomy at Starship Children's Hospital between 1 January 2007-31 December 2016. RESULTS: During the study period, 2,793 children had appendicectomy using hook diathermy to dissect the mesoappendix. No children required blood transfusions or return to theatre for bleeding. There were 103 intra-operative complications related to the use of hook diathermy (3.7%), including one case that required conversion to open for bleeding. CONCLUSION: Dissection of the mesoappendix using hook diathermy is a safe, quick and effective method during laparoscopic appendicectomy, with low complication and conversion to open rates.


Assuntos
Apendicectomia , Apendicite/cirurgia , Eletrocoagulação , Laparoscopia , Complicações Pós-Operatórias , Apendicectomia/efeitos adversos , Apendicectomia/instrumentação , Apendicectomia/métodos , Apendicite/epidemiologia , Criança , Eletrocoagulação/métodos , Eletrocoagulação/estatística & dados numéricos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Masculino , Mesocolo/irrigação sanguínea , Mesocolo/cirurgia , Nova Zelândia/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Instrumentos Cirúrgicos
10.
BMC Surg ; 19(1): 72, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262302

RESUMO

BACKROUND: Several studies have demonstrated a direct correlation between lymph node yield and survival after colectomy for cancer. Complete mesocolic excision (CME) in right colectomy (RC) reduces local recurrence but is technically demanding. Here we report our early single center experience with robotic right colectomy comparing our standardized bottom-to-up (BTU) approach of robotic RC with CME and central vessel ligation (CVL) facilitated by a suprapubic access with the "classical" medial-to-lateral (MTL) strategy. METHODS: A 4-step BTU approach of robotic RC guided by embryonal planes in the process of retrocolic mobilization with suprapubic port placement was performed in the BTU-group (n = 24; all with intention to treat cancer). In step 1 CME was initiated with caudolateral mobilization of the right colon guided by the fascia of Toldt across the duodenum and up to the Trunk of Henle. Subsequently, dissection was performed BTU right of the middle supramesenteric vessels with central ileocolic vessel ligation in step 2. Subsequent to separation of the transverse retromesenteric space and completion of mobilization the hepatic flexure in step 3, the transverse mesocolon was then transected right of the middle colic vessels in step 4. An extracorporeal side to side anastomosis was performed. We compared the outcome of the BTU-group with a MTL-group (n = 7). RESULTS: Patient characteristics like age, gender, BMI, comorbidity (ASA) and M-status were comparable among groups. There was no conversion. Overall complication rate was 35.5%. We experienced no anastomoses insufficiency, grade Dindo/Clavien III/IV complication or mortality in this study. Type I and II complications and surgical characteristics incl. OR-time, ICU- and hospital-stay were comparable between the two groups. However, the lymph node yield was superior in the BTU-group (mean 40.2 ± 17.1) when compared with the MTL-group (16,3 nodes ±8.5; p <  0,001). CONCLUSIONS: Compared to the classical MTL approach, robotic suprapubic BTU RC changes from a search of the layers bordering the oncological dissection to a consequent utilization of the planes as a retro-mesocolic guide during CME. The BTU strategy could bear the potential to increase the lymph node yield. Robotic systems may provide the technical requirements to combine advantages of both open and minimally invasive RC.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Mesocolo/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Dissecação , Feminino , Humanos , Tempo de Internação , Ligadura , Linfonodos/patologia , Masculino , Estudos Retrospectivos
11.
Surg Technol Int ; 35: 138-142, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31237343

RESUMO

BACKGROUND: In right colectomy for cancer, complete mesocolic excision and D3 lymphadenectomy each leave behind lymphatic tissue anterior and posterior to the superior mesenteric vein (SMV) and artery (SMA). In this article, we present D3 extended mesenterectomy: a surgical technique that excises the lymphatic tissue en bloc with the right colectomy specimen. MATERIAL AND METHODS: A 3D map of the mesentery of the right colon was reconstructed from staging CT-angiogram scans. The surgical technique of right colectomy with D3 extended mesenterectomy consisted of eight steps: 1) reveal the SMV and SMA; 2) isolate the ileocolic artery; 3) isolate the middle colic artery; 4) resolve the anterior mesenteric flap; 5) specimen de-vascularization; 6) colectomy; 7) resolve the posterior mesenteric flap; and 8) anastomosis. RESULTS: One-hundred-seventy-six patients (77 men) 66 years of age were operated upon from February 2011 to January 2017. There were 169 adenocarcinomas: 16.0% Stage I, 49.1% Stage II, 33.7% Stage III, 1.2% Stage IV. Tumor locations were 50.6% cecum, 41.5% ascending colon, 4.5% hepatic flexure, and 2.3% transverse colon. Mean operating time was 200 minutes, blood loss 273 ml, and length of stay 7.9 days. There were 9 anastomotic leakages and 15 reoperations. One patient underwent small bowel resection due to SMA tear. There was no postoperative mortality. The mean number of lymph nodes per specimen (40.9) was comprised of 27.1 in the D2 volume and 13.8 in the D3 volume. The mean number of metastatic lymph nodes was 1.2 in the D2 volume and 0.13 in D3. There were 7 patients with lymph node metastasis in D3, 2 of whom had node metastasis solely within D3. CONCLUSION: This study shows that 1.2% of patients would have been incorrectly diagnosed as Stage II if extended D3 mesenterectomy had not been performed. Similarly, lymph node metastases would have been left behind in 4.1% of patients if extended D3 mesenterectomy had not been performed.


Assuntos
Colectomia , Colo Transverso , Neoplasias do Colo , Laparoscopia , Idoso , Colectomia/métodos , Neoplasias do Colo/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Masculino , Mesocolo/cirurgia
12.
Dis Colon Rectum ; 62(7): 894-897, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31188192

RESUMO

INTRODUCTION: There is growing evidence supporting complete mesocolic excision as the optimal surgical approach for right-sided colon cancer to improve oncologic outcomes in comparison with conventional surgical resection. Although the feasibility of a minimally invasive approach to complete mesocolic excision has been reported, obesity has been associated with increased difficulty for finding the correct plane for dissection and delineating the vascular anatomy. We describe a novel approach with early identification of and dissection along the superior mesenteric vein during robotic complete mesocolic excision surgery, for all patients, regardless of BMI. TECHNIQUE: The dissection is initiated with identification of the superior mesenteric vein as the starting point. Then, the vascular dissection is performed along the anterior superior mesenteric vein plane while observing complete mesocolic excision principles. The anterior superior mesenteric vein plane is an optimal and safe dissection plane because there are no anterior tributaries. The ileocolic vein and artery are ligated separately at their junction with the superior mesenteric vein and superior mesenteric artery. The dissection is then continued cephalad along the superior mesenteric vein, identifying additional colic arteries, including the middle colic arterial trunk as well as the venous tributaries to the superior mesenteric vein such as the gastrocolic trunk. The superior right colic vein is then ligated at the gastrocolic confluence and the middle colic vessels are ligated. After the vascular dissection is completed, the colon is then mobilized. RESULTS: A total of 66 patients received the "superior mesenteric vein-first" approach for robotic colectomy between 2013 and 2018, including 40.9% patients with BMI >30 kg/m. Median lymph node yield was 32 (interquartile range, 25-40). The median distance to the high vascular tie was 12 cm (interquartile range, 7-19). Median estimated blood loss was 33 mL (interquartile range, 25-50). Overall rate of grade ≥3 complications was 3.0%. CONCLUSIONS: Using the superior mesenteric vein-first approach, robotic complete mesocolic excision for right colectomy can be performed on patients with high or low BMI with excellent short-term oncologic outcomes and acceptable morbidity. See Video Abstract at http://links.lww.com/DCR/A960.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Veias Mesentéricas/cirurgia , Mesocolo/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Dissecação , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade
13.
Langenbecks Arch Surg ; 404(5): 557-564, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31243573

RESUMO

BACKGROUND: Since the implementation of total mesorectal excision (TME) in rectal cancer surgery, oncological outcomes improved dramatically. With the technique of complete mesocolic excision (CME) with central vascular ligation (CVL), the same surgical principles were introduced to the field of colon cancer surgery. Until now, current literature fails to invariably demonstrate its oncological superiority when compared to conventional surgery, and there are some concerns on increased morbidity. The aim of this study is to compare short-term outcomes after left-sided laparoscopic CME versus conventional surgery. METHODS: In this retrospective analysis, data on all laparoscopic sigmoidal resections performed during a 3-year period (October 2015 to October 2018) at our institution were collected. A comparative analysis between the CME group-for sigmoid colon cancer-and the non-CME group-for benign disease-was performed. RESULTS: One hundred sixty-three patients met the inclusion criteria and were included for analysis. Data on 66 CME resections were compared with 97 controls. Median age and operative risk were higher in the CME group. One leak was observed in the CME group (1/66) and 3 in the non-CME group (3/97), representing no significant difference. Regarding hospital stay, postoperative complications, surgical site infections, and intra-abdominal collections, no differences were observed. There was a slightly lower reoperation (1.5% versus 6.2%, p = 0.243) and readmission rate (4.5% versus 6.2%, p = 0.740) in the CME group during the first 30 postoperative days. Operation times were significantly longer in the CME group (210 versus 184 min, p < 0.001), and a trend towards longer pathological specimens in the CME group was noted (21 vs 19 cm, p = 0.059). CONCLUSIONS: CME does not increase short-term complications in laparoscopic left-sided colectomies. Significantly longer operation times were observed in the CME group.


Assuntos
Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Laparoscopia/efeitos adversos , Mesocolo/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Neoplasias do Colo/patologia , Feminino , Humanos , Tempo de Internação , Ligadura , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(5): 436-440, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31104428

RESUMO

According to multicenter randomized controlled trials, laparoscopic radical resection of colon cancer has the same short and long term clinical efficacy as traditional open surgery. In laparoscopic radical resection of right semicolon cancer, it is important to separate the embryonic plane of the root, and to ligate and cut off the central vascular roots. Only by separation along the membrane space can one achieve minimally invasive operation with no bleeding, and ensure the integrity of the excision of the mesangium and avoid damage of internal fascia and other organs. The mesangial distribution of the right semicolon is adjacent to the mesangium of the stomach and is connected to the mesentery of the small intestine. The pancreaticoduodenum locates between the right semicolon mesentery and the retroperitoneal subperitoneal fascia. In particular, the relationship between the anterior and posterior Treitz fascia of the pancreaticoduodenum and the Toldt space is complex, which is closely related to the feasibility of complete mesocolic excision(CME). This article introduces the distribution of intermembranous space and mesangial bed in the right semicolon, presenting the problem in CME surgery. In addition, there are key points in identifying the gap between the membranes based on the author's experience and we propose a new evaluation criteria for membrane surgical specimens, which has certain guiding significance for radical CME surgery for right semicolon cancer.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Mesocolo/anatomia & histologia , Mesocolo/cirurgia , Neoplasias do Colo/patologia , Fáscia/anatomia & histologia , Fáscia/patologia , Fasciotomia , Humanos , Laparoscopia , Mesentério/patologia , Mesocolo/patologia , Peritônio/anatomia & histologia , Peritônio/patologia , Peritônio/cirurgia
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(4): 392-397, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31054555

RESUMO

Rectal cancer has become one of the most common malignant tumors in our country. The treatment of total mesorectal excision after neoadjuvant chemoradiotherapy (NCRT) has become a standard treatment mode for locally advanced rectal cancer. However, the response of patients with rectal cancer to neoadjuvant chemotherapy varies, and treating all patients with NCRT may be suboptimal. Accurately predicting the efficacy and sensitivity of NCRT can help adjust treatment plan timely and avoid delay of condition in patients who are insensitive to NCRT. Existing research has confirmed that TNM staging, tumor regression grade and tumor markers and other clinical indicators can effectively predict the efficacy and sensitivity of NCRT, all kinds of clinical guidelines also recommend the three as a routine examination of patients with rectal cancer during NCRT. However, with the proposal of the concept of "Precise Medicine", the above clinical indexes cannot meet the clinical need of accurate treatment of rectal cancer. In recent years, with the accumulating studies on tumor immunotherapy, researchers have found that the sensitivity of NCRT is not only related to tumor biological characteristics, but also closely related to tumor microenvironment. Based on the current research, the indicators of tumor microenvironment, such as lymphocyte subsets count, neutrophil-lymphocyte ratio and programmed cell death ligand 1, have great potential clinical value in predicting the efficacy and sensitivity of rectal cancer. Further research based on relevant indicators of tumor microenvironment will enable accurate prediction of NCRT efficacy and sensitivity of NCRT and has important clinical significance for the realization of accurate and individualized treatment of rectal cancer.


Assuntos
Quimiorradioterapia Adjuvante , Terapia Neoadjuvante , Neoplasias Retais/terapia , Humanos , Mesocolo/cirurgia , Estadiamento de Neoplasias , Protectomia , Prognóstico , Neoplasias Retais/imunologia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Resultado do Tratamento
17.
Ann Surg Oncol ; 26(8): 2516, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30927197

RESUMO

BACKGROUND: Laparoscopic complete mesocolic excision (CME) for hepatic or splenic flexural colon cancer is considered technically demanding. The double (hepatic and splenic) flexural colon cancers are rare, and the laparoscopic CME procedure for such disease is not standardized. METHODS: This video presents laparoscopic CME for double (hepatic and splenic) flexural colon cancers using a medial and cranial approach. RESULTS: The patient was a 60-year-old woman with the diagnosis of splenic flexure cancer (cT4N1M0) and hepatic flexure cancer (cT3N0M0). Laparoscopic subtotal colectomy was performed. First, the left colic artery was divided at its origin, and the inferior mesenteric vein also was divided at the same level. The descending mesocolon was widely separated from the retroperitoneal tissues using a medial approach. Then, lymph node dissection along the surgical trunk was performed using a cranial approach. Finally, the transverse mesocolon was divided at the inferior border of the pancreas, and CME was achieved. The specimen was extracted through a small incision at the umbilicus, and side-to-side ileo-sigmoid anastomosis was performed extracorporeally. CONCLUSIONS: The approach presented in the video might be useful for standardization of laparoscopic CME for double flexural colon cancers.


Assuntos
Colectomia/métodos , Colo Transverso/cirurgia , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Veias Mesentéricas/cirurgia , Mesocolo/cirurgia , Colo Transverso/patologia , Neoplasias do Colo/patologia , Feminino , Humanos , Veias Mesentéricas/patologia , Mesocolo/patologia , Pessoa de Meia-Idade , Prognóstico , Gravação em Vídeo
18.
Tech Coloproctol ; 23(3): 251-257, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30838463

RESUMO

BACKGROUND: Although complete mesocolic excision has been performed for 10 years there remains no published prospective data. The lack of a classification which includes completeness of mesocolic tissue removal as well as plane of surgery contributes to the problem of comparing studies. The aim of the present study was to develop such a classification for right hemicolectomy. METHODS: In a prospective, non-randomized trial we collected specimens of right hemicolectomies from 38 German hospitals between February 2012 and October 2016. The degree of radicality of resection was reported. Photographs were taken of the specimens. After screening the images it became apparent that the specimens could be divided into four main groups according to the degree of missing mesocolic tissue, and three subgroups reflecting the plane of surgery. RESULTS: Of 1373 patients 1097 images were available. Grading was possible in 1077 (98.2%). Distribution was Type 0 (best) 38.6%, Type I 43.3%, Type II 8.5%, Type III (poorest) 7.8%. Surgery was considered to be in a suboptimal plane of surgery in 15.2% overall, highest in Type III (37%) and lowest in Type 0 (7.8%, p < 0.001). CONCLUSIONS: The proposed classification may be a relevant tool for the further investigation of CME for right colon cancer because it allows us to differentiate the aspects of lymphadenectomy and the preservation of the integrity of the mesocolon.


Assuntos
Colectomia/classificação , Neoplasias do Colo/cirurgia , Mesocolo/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colectomia/métodos , Neoplasias do Colo/patologia , Feminino , Humanos , Excisão de Linfonodo/classificação , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estudos Prospectivos
19.
Ann R Coll Surg Engl ; 101(4): e108-e110, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30854871

RESUMO

Solitary fibrous tumours are rare mesenchymal tumours which mostly arise from pleura. Such tumours occurring in the mesocolon are exceptionally rare. A 35-year-old man was referred to the general surgery department with a painless and nonpalpable mass in the right quadrant of the abdomen, which was detected incidentally on magnetic resonance imaging. The patient had no symptoms and the physical examination revealed no findings. The patient underwent surgical resection and excisional biopsy results revealed an intra-abdominal solitary fibrous tumour originating from the ascending mesocolon. He was discharged two days after surgery and remained disease-free at the end of the two-month follow-up period.


Assuntos
Mesocolo , Neoplasias Peritoneais/diagnóstico , Tumores Fibrosos Solitários/diagnóstico , Adulto , Humanos , Achados Incidentais , Imagem por Ressonância Magnética , Masculino , Mesocolo/diagnóstico por imagem , Mesocolo/patologia , Mesocolo/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/patologia , Tumores Fibrosos Solitários/cirurgia
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