Abstract:

Objective

To explore the clinical effect of complete mesocolic excision （CME） plus D3 radical resection with the superior mesenteric artery （SMA） as the medial boundary in patients with advanced colon cancer.

Methods

A total of 62 patients with advanced right-sided colon cancer who underwent CME plus D3 radical resection from January 2020 to December 2023 were selected as the research objects.They were divided into the control group （n=31 cases） and the observation group （n=31 cases） by the random number table method.In the control group，the left edge of the superior mesenteric vein （SMV） was taken as the medial boundary of lymph node dissection，while in the observation group，the left edge of the superior mesenteric artery（SMA） was taken as the medial boundary of lymph node dissection.The statistical software SPSS 27.0 was used for data analysis.Measurement data such as perioperative indexes and postoperative pathological conditions were expressed as （±s），and independent samples t test was performed.The incidence of postoperative complications was expressed as a rate，and the chi-square test was used for comparison between groups.A P value less than 0.05 was considered statistically significant.

Results

There were no statistically significant differences in operation time，intraoperative blood loss，ventilation time，length of hospital stay，tumor diameter，and degree of tumor differentiation between the two groups （P＞0.05）.The drainage tube placement time in the observation group was longer than that in the control group，and the postoperative drainage volume，the number of positive lymph nodes，and the total number of dissected lymph nodes were all more than those in the control group （P＜0.05）.There was no statistically significant difference in the total incidence of postoperative complications between the control group and the observation group （19.4% vs. 6.5%，P＞0.05）.After a 2-year follow-up，there was no statistically significant difference in the cumulative overall survival rate between the two groups （87.1% vs. 93.5%，Log-Rankχ²=0.675，P＞0.05）.The cumulative recurrence-free and metastasisfree survival rate in the observation group was higher than that in the control group，and the difference was statistically significant （90.3% vs. 64.5%，Log-Rankχ²=5.453，P＜0.05）.

Conclusion

For patients with advanced right-sided colon cancer，when performing CME plus D3 radical resection，taking the left edge of the superior mesenteric artery （SMA） as the medial boundary of lymph node dissection can improve the quality of lymph node dissection，which is of positive significance for improving the prognosis of patients.

Key words: Right Colon Cancer, Total Mesocolectomy, Superior Mesenteric Artery, Lymph Node Dissection