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Desouza AL, Kazi MM, Nadkarni S, Shetty P, T V, Saklani AP. Complete mesocolic excision for right colon cancer: Is D3 lymphadenectomy necessary? Colorectal Dis 2024; 26:63-72. [PMID: 38017593 DOI: 10.1111/codi.16815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/30/2023]
Abstract
AIM Although complete mesocolic excision (CME) for colon cancer is oncologically sound, to date, there has been no consensus on the extent of lymphadenectomy in radical right colectomy. This study essentially compared the perioperative and survival outcomes of CME with two templates of lymphadenectomy for right colon cancer. METHOD This was a propensity matched, retrospective analysis of a single centre, prospectively maintained database of all patients undergoing elective right colectomy for nonmetastatic, biopsy-proven adenocarcinoma from November 2013 to October 2018. CME + D3 was adopted selectively, documented prospectively, and compared with patients undergoing CME + central vascular ligation (CVL). The only technical difference between the groups was the excision of the surgical trunk of Gillot in the CME + D3 group. Postoperative, long-term outcomes and patterns of recurrence were compared between the groups. RESULTS Of the 244 eligible patients, 88 (36.1%) and 156 (63.9%) underwent CME + D3 and CME + CVL, respectively. Matched groups (72 [CME + D3] vs. 108 [CME + CVL]) showed no difference in histology, tumour grade, postoperative complications, mortality, and hospital stay. CME + D3 was preferentially performed laparoscopically (35.2% vs. 9%), was associated with lower blood loss (215 mL vs. 297 mL, p = 0.001), higher nodal yield (31 vs. 25 nodes, p = 0.003) and a higher incidence of chyle leak (4 vs. 0, p = 0.013). At a median follow-up of more than 57 months, there was no significant difference in local recurrence, disease-free or overall survival. CONCLUSION In this retrospective study, lymphadenectomy along the superior mesenteric vein, as a component of CME for right colon cancer, offered a higher nodal yield with no improvement in oncological outcome. Dissection of the SMV, over and above a D2 dissection, could therefore be restricted to specialized colorectal units until further studies establish the incremental oncological benefit of this extended lymphadenectomy or define a patient group in whom it is beneficial.
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Affiliation(s)
- Ashwin L Desouza
- Department of Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Mufaddal M Kazi
- Department of Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Shravan Nadkarni
- Department of Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Preethi Shetty
- Department of Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Vipin T
- Department of Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - Avanish P Saklani
- Department of Surgery, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
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Kutlu B, Benlice C, Kocaay F, Gungor Y, Ismail E, Akyol C, Yilmaz M, Ozdemir M, Acar HI, Elhan AH, Kuzu MA. Computer-based multimodal training module facilitates standardization of complete mesocolic excision technique for right-sided colon cancer: Long-term oncological outcomes. Colorectal Dis 2021; 23:3141-3151. [PMID: 34346554 DOI: 10.1111/codi.15857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study is to demonstrate our video training tool developed to teach and standardize complete mesocolic excision (CME) for right-sided colon cancer and also to present our long-term oncological outcomes. METHOD Educational narrative videos were produced to demonstrate the technical steps of CME. First, a three-dimensional animation video was prepared. Then cadaveric dissections were recorded in a step-by-step fashion, following the sequences of open and minimally invasive surgery. These were followed by videos of real-life demonstrations of surgical procedures, enhanced by superimposed animations of key anatomical structures. In order to demonstrate the impact of this training module on outcomes of patients undergoing CME, we retrospectively queried data from before (2005-2010) and after (2011-2019) implementation of standardized CME in our practice. RESULTS A total of 180 consecutive patients underwent right hemicolectomy between 2005 and 2019. Fifty-four patients underwent surgery before and 126 patients after CME principles were elaborated and standardized. Of those patients who had surgery after the training module, 58 (46%) underwent open surgery and 68 (54%) underwent laparoscopic colectomy. Demographics, perioperative parameters and morbidity were comparable between the groups. The 5-year overall and disease-free survival rates were significantly improved after implementation of CME training (p = 0.059 and p = 0.041, respectively). Also, 5-year overall and disease-free survival rates for all patients were considerably better than our reported national outcomes. CONCLUSION Our comprehensive step-by-step training video module for the CME technique demonstrates surgical anatomical planes and important vascular structures and variations. The video also helps standardization of the CME technique and should contribute to improved histopathological and oncological outcomes.
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Affiliation(s)
- Burak Kutlu
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Cigdem Benlice
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Firat Kocaay
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Yigit Gungor
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Erkin Ismail
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Cihangir Akyol
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mehmet Yilmaz
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mehtap Ozdemir
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Halil Ibrahim Acar
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Atilla Halil Elhan
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mehmet Ayhan Kuzu
- Departments of General Surgery, Anatomy and Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
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Right-side colectomy with complete mesocolic excision vs conventional right-side colectomy in the treatment of colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:1885-1904. [PMID: 33983451 DOI: 10.1007/s00384-021-03951-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This meta-analysis aims to investigate the role of complete mesocolic excision (CME) in the treatment of right-side colon cancer when compared with standard right-side hemicolectomy, focusing on oncological outcomes, mortality and morbidity rates. MATERIALS AND METHODS A systematic literature search was performed on MEDLINE and EMBASE archives, including studies on CME in right-side colon cancer. Primary outcomes were five-year disease-free survival and five-year overall survival. Secondary outcomes investigated were mortality and morbidity rates, intraoperative blood loss, anastomotic leakage, postoperative ileus, day of postoperative flatus, pulmonary infection, duration of hospital stay and number of lymph nodes harvested. RESULTS Seventeen studies have been included in this meta-analysis for a total of 3918 patients. The five-year disease-free survival (DFS) and overall survival (OS) results improved in the CME group with respect to conventional right-side colectomy with an OR 1.88 (95% CI 1.02-3.45) and OR 2.77 (95% CI 1.33-5.74), respectively. The incidence of mortality and morbidity was comparable between the two groups. Moreover, conventional surgery time was faster than CME (MD 33.69 min, 95% CI 12.79-54.59), while no significant differences were reported in mean blood loss and hospital stay. Furthermore, the CME group showed a higher mean number of harvested lymph nodes (MD 7.08 lymph nodes 95% CI 4.90-9.27). CONCLUSION Complete mesocolic excision of the right-side colectomy improves oncological outcomes without increasing mortality and morbidity rates compared to standard right-side hemicolectomy. CME should therefore be routinely performed in the treatment of right-side colon cancer.
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Emile SH. Qualitative umbrella review of systematic reviews on complete mesocolic excision for colon cancer. J Visc Surg 2021; 159:286-297. [PMID: 34020910 DOI: 10.1016/j.jviscsurg.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) of colon cancer with extended lymphadenectomy was suggested to improve radical resection of colon cancer. This comprehensive review aimed to assess the current literature for the outcomes of CME of colon cancer through an appraisal of the findings of published systematic reviews and meta-analyses. METHODS A systematic literature review searching for the studies that assessed the outcome of CME of colon cancer was conducted. Electronic databases were queried from 2009 through November 2020. The main objectives of this review were to illustrate the technical aspects and outcome of CME and to summarize the findings of the published systematic reviews. RESULTS Thirteen systematic reviews were retrieved. All reviews found CME to provide longer bowel, larger area of mesentery resected, and more lymph nodes (LNs) retrieved than standard colectomy. All systematic reviews except two found similar complication rates between CME and standard colectomy. Four systematic reviews documented the survival benefit of CME in regards to improved overall and disease-free survival. Using the laparoscopic approach for CME did not compromise the oncologic outcomes of the procedures, yet was associated with less intraoperative blood loss, faster recovery, and potential survival benefits. CONCLUSIONS CME is associated with better specimen quality, more LNs clearance, and potential survival benefits compared to standard colectomy. However, the lack of robust data from well-designed multicenter randomized trials may prevent drawing firm conclusions on the oncologic benefits of CME. Further high-quality studies are needed before recommending CME as the standard of care for colon cancer.
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Affiliation(s)
- S H Emile
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura city, Egypt.
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Crafa F, Vanella S, Neola B, Miro A, Coppola Bottazzi E. Hemicolectomy with complete mesocolic excision: description of an open and laparoscopic approach - A video vignette. Colorectal Dis 2021; 23:1280-1281. [PMID: 33540488 DOI: 10.1111/codi.15565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Francesco Crafa
- Oncological and General Surgery Unit, Hospital of National Relevance and High Speciality 'St, Giuseppe Moscati', Avellino, Italy
| | - Serafino Vanella
- Oncological and General Surgery Unit, Hospital of National Relevance and High Speciality 'St, Giuseppe Moscati', Avellino, Italy
| | - Benedetto Neola
- Oncological and General Surgery Unit, Hospital of National Relevance and High Speciality 'St, Giuseppe Moscati', Avellino, Italy
| | - Antonio Miro
- Oncological and General Surgery Unit, Hospital of National Relevance and High Speciality 'St, Giuseppe Moscati', Avellino, Italy
| | - Enrico Coppola Bottazzi
- Oncological and General Surgery Unit, Hospital of National Relevance and High Speciality 'St, Giuseppe Moscati', Avellino, Italy
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Larach JT, Flynn J, Wright T, Rajkomar AKS, McCormick JJ, Kong J, Smart PJ, Heriot AG, Warrier SK. Robotic complete mesocolic excision versus conventional robotic right colectomy for right-sided colon cancer: a comparative study of perioperative outcomes. Surg Endosc 2021; 36:2113-2120. [PMID: 33844084 DOI: 10.1007/s00464-021-08498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
AIM This study aims to compare the short-term outcomes of robotic complete mesocolic excision (RCME) versus conventional robotic right colectomy (RRC) for right-sided colon cancer. METHODS Consecutive patients who underwent robotic surgery for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and June 2020 were included. Clinical, perioperative and histopathological variables were collected and analysed. RESULTS Fifty-one patients were included; 25 (49%) of them had an RCME. The groups were evenly distributed in terms of demographic characteristics and tumour location. Operative time was similar between both groups, and no patients required conversion to open surgery. There were no differences in overall complications (16% in RCME vs. 26.9% in RRC; p = 0.499) or their profile between groups. There were no anastomotic leaks recorded, and the reoperation rates were similar (0% for RCME versus 3.8% for RRC; p = 1). In addition, the median length of hospital stay was similar in between the RCME and the RRC groups (4 [4-6] days versus 5 [3-8.5] days, respectively; p = 0.891). Whilst there were no differences in the TNM staging, the mean number of lymph nodes harvested with RCME was 37.7 (±12.9) compared to 21.8 (±7.5) with RCC (p < 0.001). CONCLUSION In our series, RCME was associated with a higher lymph node harvest and a similar morbidity profile compared to RCC. Further studies are required to validate these results and provide long-term oncologic outcomes.
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Affiliation(s)
- José Tomás Larach
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Julie Flynn
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Timothy Wright
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Amrish K S Rajkomar
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Jacob J McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Joseph Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Philip J Smart
- General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia.,Department of Surgery, Austin Health, Melbourne, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,General Surgery and Gastrointestinal Clinical Institute, Epworth Healthcare, Melbourne, Australia
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Wang B, Wu Z, Zhang R, Chen Y, Dong J, Qi X. Retrospective analysis of safety and efficacy of enhanced recovery pathways in stage II-III colorectal cancer patients submitted to surgery and adjuvant therapy. World J Surg Oncol 2021; 19:99. [PMID: 33823871 PMCID: PMC8025484 DOI: 10.1186/s12957-021-02203-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
Background The American Society of Colon and Rectal Surgeons is suggesting laparoscopic surgeries for colorectal cancer. Conventional perioperative procedures like long preoperative fasting and bowel procedures are not useful and harmful to patients undergoing surgeries for colorectal cancer. The objectives of the study were to compare surgery outcomes, hospital stays, and survival of patients who received fast-track (laparoscopy/open) surgical procedure followed by chemotherapy against those who received conventional (laparoscopy/open) surgical procedure followed by chemotherapy for colorectal cancer. Methods The study analyzes the outcomes of a total of 542 colorectal cancer (preoperative biopsies stage II or III) patients submitted to surgery and adjuvant chemotherapy. The study cohort is retrospectively subdivided in 4 groups submitted to open or laparoscopic resection with or without fast-track protocol appliance and two different chemotherapy regimens. Patients who ended up being TNM stage I have not received the adjuvant chemotherapy. Results The fast-track surgical procedure had shorter total hospital stays and postoperative hospital stays than the conventional surgical procedures. Flatus resumption time, the time until first defecation, and intraoperative blood loss were shorter for the fast-track surgical procedures than the conventional surgical procedures. Those surgery outcomes were also shorter for the fast-track laparoscopy than the open fast-track. Resumption of a fluid diet and ambulation onset time were shorter for the fast-track surgical procedures than the conventional surgical procedures. The surgical checkpoints that were compliance by patient of fast-track surgeries were significantly fewer than those of the conventional surgeries. Clinically significant difference for QLQ-C30/CR38 score after chemotherapy was reported between patients who received open conventional surgeries and those patients who received fast-track laparoscopy (59.63 ± 2.26 score/patient vs. 71.67 ± 5.19 score/patient). There were no significant differences for the number of patients with any grade adverse effects (p = 0.431) or with grade 3–4 adverse effects (p = 0.858), and the disease-free and overall survival among cohorts. Conclusions The fast-track surgical procedure is effective and safe even in a multidisciplinary scenario as colorectal cancer treatment in which surgery is only a part of management. Level of evidence: III Technical efficacy stage: 4.
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Affiliation(s)
- Baoxin Wang
- Department of Oncology, Hebei Petrochina Central Hospital, Heibei, Langfang, 065000, China
| | - Zhenming Wu
- Department of Oncology, Hebei Petrochina Central Hospital, Heibei, Langfang, 065000, China
| | - Rui Zhang
- Department of Oncology, Hebei Petrochina Central Hospital, Heibei, Langfang, 065000, China
| | - Yue Chen
- Department of Oncology, Hebei Petrochina Central Hospital, Heibei, Langfang, 065000, China
| | - Jiuxing Dong
- Department of Oncology, Hebei Petrochina Central Hospital, Heibei, Langfang, 065000, China
| | - Xiuheng Qi
- Department of Oncology, Hebei Petrochina Central Hospital, Heibei, Langfang, 065000, China.
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