安全性と根治性の向上を目指した右側結腸癌に対する腹腔鏡手術手技の工夫

Modified procedures in laparoscopic right hemi-colectomy for improving safety and curability

◆要旨：［目的］腹腔鏡下結腸右半切除術（以下，Lap-RHC）の安全性と根治性の向上を目指した手技の変更点を示し，有用性を明らかにする．［方法］Lap-RHCを行った100例について，手技変更前（A群）と変更後（B群）の短期成績を比較した．手技の変更点は以下である．1）ポート配置をco-axial settingとしてリンパ節郭清操作における鉗子の挿入角度を変更した．2）手縫い腸管吻合に変更し，腸間膜への緊張を緩和した．［結果］両群間で短期成績に差はなかった．B群では，肥満症例においても遠位断端距離が保たれ，中枢リンパ節郭清個数に差はないが，全リンパ節郭清個数は有意に多かった（p＝0.04）．［結論］手技の工夫により，安全性を保ちつつ遠位断端距離を確保できる可能性があると考えられた．

　［Aim］We had changed the procedures of laparoscopic right hemi-colectomy（Lap-RHC） for right-sided colon cancer since January 2021 and focused on the following 2 points to overcome several difficulties : 1）The port setting for precise lymphadenectomy; 2）The prevention of bleeding suffered from excessive traction of the intestine. Here, we presented our specific methods of these issues and assessed the usefulness of the procedures.［Patients/Methods］The records of 100 right-sided colon cancer patients who underwent Lap-RHC between April 2018 and March 2023 were analyzed retrospectively, including 52 cases with new procedures as follows : 1）Placing on the left upper port at 45 degree obliquely cranial lateral to the umbilical port, which is higher in the abdomen from the previous port setting. As a result, it made its possible to approach the branch of the superior mesenteric artery more vertically. 2）Changing the anastomosis procedures from by using the stapler to hand-sewn anastomosis to reduce the risk of bleeding due to the excessive traction of the intestine.［Results］There were no difference in short-term results between the two groups. In the new procedures group, the distal margin was preserved even in obese patients. The number of total lymph nodes harvested were significantly greater in new procedures than previous methods（median 25, p＝0.04）, however those of central lymph nodes were comparable in two groups.［Conclusions］In the new procedures, the distal margin maybe secured while maintaining safety. We would continue to keep these concepts to perform adequate surgery.