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Sun Z, Zhang G, Lu J, Wu B, Lin G, Xiao Y, Xu L. Risk Factors for Postoperative Complications of Laparoscopic Right Colectomy: A Post Hoc Analysis of the RELARC Trial. Dis Colon Rectum 2024; 67:1194-1200. [PMID: 38773832 PMCID: PMC11309329 DOI: 10.1097/dcr.0000000000003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND There is concern regarding the possibility of postoperative complications for laparoscopic right colectomy. OBJECTIVE To evaluate the risk factors for postoperative complications for patients undergoing laparoscopic right colectomy. DESIGN This was an observational study. SETTINGS This was a post hoc analysis of a prospective, multicenter, randomized controlled trial (RELARC trial, NCT02619942). PATIENTS Patients included in the modified intention-to-treat analysis in the RELARC trial were all enrolled in this study. MAIN OUTCOME MEASURES Risk factors for postoperative complications were identified using univariate and multivariable logistic regression analysis. RESULTS Of 995 patients, 206 (20.7%) had postoperative complications. Comorbidity ( p = 0.02; OR: 1.544; 95% CI, 1.077-2.212) and operative time >180 minutes ( p = 0.03; OR: 1.453; 95% CI, 1.032-2.044) were independent risk factors for postoperative complications, whereas female sex ( p = 0.04; OR: 0.704; 95% CI, 0.506-0.980) and extracorporeal anastomosis ( p < 0.001; OR: 0.251; 95% CI, 0.166-0.378) were protective factors. Eighty patients (8.0%) had overall surgical site infection, 53 (5.3%) had incisional surgical site infection, and 33 (3.3%) had organ/space surgical site infection. Side-to-side anastomosis was a risk factor for overall surgical site infection ( p < 0.001; OR: 1.912; 95% CI, 1.118-3.268) and organ/space surgical site infection ( p = 0.005; OR: 3.579; 95% CI, 1.455-8.805). The extracorporeal anastomosis was associated with a reduced risk of overall surgical site infection ( p < 0.001; OR: 0.239; 95% CI, 0.138-0.413), organ/space surgical site infection ( p = 0.002; OR: 0.296; 95% CI, 0.136-0.646), and incisional surgical site infection ( p < 0.001; OR: 0.179; 95% CI, 0.099-0.322). Diabetes ( p = 0.039; OR: 2.090; 95% CI, 1.039-4.205) and conversion to open surgery ( p = 0.013; OR: 5.403; 95% CI, 1.437-20.319) were risk factors for incisional surgical site infection. LIMITATIONS Due to the retrospective nature, the key limitation is the lack of prospective documentation and standardization regarding the perioperative management of these patients, such as preoperative optimization, bowel preparation regimens, and antibiotic regimens, which may be confounder factors of complications. All surgeries were performed by experienced surgeons, and the patients enrolled were relatively young, generally healthy, and without obesity. It is unclear whether the results will be generalizable to obese and other populations worldwide. CONCLUSIONS Male sex, comorbidity, prolonged operative time, and intracorporeal anastomosis were independent risk factors for postoperative complications of laparoscopic right colectomy. Side-to-side anastomosis was associated with an increased risk of organ/space surgical site infection. Extracorporeal anastomosis could reduce the incidence of overall surgical site infection. Diabetes and conversion to open surgery were associated with an increased risk of incisional surgical site infection. See Video Abstract . CLINICALTRIALSGOV IDENTIFIER NCT02619942. FACTORES DE RIESGO DE COMPLICACIONES POSOPERATORIAS EN COLECTOMA DERECHA LAPAROSCPICA UN ANLISIS POST HOC DEL ENSAYO RELARC ANTECEDENTES:Existe preocupación con respecto a la posibilidad de complicaciones postoperatorias en colectomía derecha laparoscópica.OBJETIVO:Evaluar los factores de riesgo de complicaciones postoperatorias en pacientes sometidos a colectomía derecha laparoscópica.DISEÑO:Este fue un estudio observacional.ENTORNO CLINICO:Este fue un análisis post hoc de un ensayo controlado aleatorio, multicéntrico y prospectivo: ensayo RELARC (NCT02619942).PACIENTES:Todos los pacientes incluidos en el análisis de intención de tratar modificado en el ensayo RELARC fueron inscritos en este estudio.PRINCIPALES MEDIDAS DE RESULTADO:Los factores de riesgo de complicaciones posoperatorias se identificaron mediante análisis de regresión logística univariante y multivariable.RESULTADOS:De 995 pacientes, 206 (20,7%) tuvieron complicaciones postoperatorias. La comorbilidad ( p = 0,02, OR: 1,544, IC 95%: 1,077-2,212) y el tiempo operatorio >180 min ( p = 0,03, OR: 1,453, IC 95%: 1,032-2,044) fueron factores de riesgo independientes de complicaciones postoperatorias. Mientras que el sexo femenino ( p = 0,04, OR: 0,704, IC 95%: 0,506-0,980) y la anastomosis extracorpórea ( p < 0,001, OR: 0,251, IC 95%: 0,166-0,378) fueron factores protectores. 80 (8,0%) tenían infección general del sitio quirúrgico (ISQ), 53 (5,3%) tenían ISQ incisional y 33 (3,3%) tenían ISQ de órgano/espacio. Anastomosis latero-lateral fue un factor de riesgo para la ISQ general ( p < 0,001, OR: 1,912, IC 95%: 1,118-3,268) y ISQ órgano/espacio ( p = 0,005, OR: 3,579, IC 95%: 1,455-8.805). La anastomosis extracorpórea se asoció con un riesgo reducido de ISQ general ( p < 0,001, OR: 0,239, IC 95%: 0,138-0,413), ISQ órgano/espacio ( p = 0,002, OR: 0,296, IC 95%: 0,136-0,646), e ISQ incisional ( p < 0,001, OR: 0,179, IC 95%: 0,099-0,322). Diabetes ( p = 0,039, OR: 2,090, IC 95%: 1,039-4,205) y la conversión a cirugía abierta ( p = 0,013, OR: 5,403, IC 95%: 1,437-20,319) fueron factores de riesgo para ISQ incisional.LIMITACIONES:Debido a la naturaleza retrospectiva, la limitación clave es la falta de documentación prospectiva y estandarización sobre el manejo perioperatorio de estos pacientes, como la optimización preoperatoria, los regímenes de preparación intestinal y los regímenes de antibióticos, que pueden ser factores de confusión de las complicaciones. Todas las cirugías fueron realizadas por cirujanos experimentados y los pacientes inscritos eran relativamente jóvenes, generalmente sanos y no obesos. No está claro si los resultados serán generalizables a las poblaciones obesas y de otro tipo en todo el mundo.CONCLUSIONES:Sexo masculino, comorbilidad, el tiempo operatorio prolongado y anastomosis intracorpórea fueron factores de riesgo independientes de complicaciones postoperatorias de la colectomía derecha laparoscópica. Anastomosis latero-lateral se asoció con un mayor riesgo de SSI de órgano/espacio. La anastomosis extracorpórea podría reducir la incidencia de ISQ general. La diabetes y la conversión a cirugía abierta se asociaron con un mayor riesgo de ISQ incisional. (Traducción- Dr. Francisco M. Abarca-Rendon ).
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Affiliation(s)
- Zhen Sun
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guannan Zhang
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyang Lu
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Wu
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guole Lin
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Xiao
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lai Xu
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lu J, Xing J, Zang L, Zhang C, Xu L, Zhang G, He Z, Sun Y, Feng Y, Du X, Hu S, Chi P, Huang Y, Wang Z, Zhong M, Wu A, Zhu A, Li F, Xu J, Kang L, Suo J, Deng H, Ye Y, Ding K, Xu T, Zhang Y, Zhang Z, Zheng M, Su X, Xiao Y. Extent of Lymphadenectomy for Surgical Management of Right-Sided Colon Cancer: The Randomized Phase III RELARC Trial. J Clin Oncol 2024:JCO2400393. [PMID: 39190853 DOI: 10.1200/jco.24.00393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/09/2024] [Accepted: 06/18/2024] [Indexed: 08/29/2024] Open
Abstract
PURPOSE Complete mesocolic excision (CME) is being increasingly used for the treatment of right-sided colon cancer, although there is still no strong evidence that CME provides better long-term oncological outcomes than D2 dissection. The controversy is mainly regarding the survival benefit from extended lymph node dissection emphasized by CME. METHODS This multicenter, open-label, randomized controlled trial (ClinicalTrials.gov identifier: NCT02619942) was performed across 17 hospitals in China. Patients diagnosed with stage T2-T4aNanyM0 or TanyN + M0 right-sided colon cancer were randomly assigned (1:1) to undergo either CME or D2 dissection during laparoscopic right colectomy. The primary outcome was the 3-year disease-free survival (DFS), and the main secondary outcome was the 3-year overall survival (OS). RESULTS Between January 11, 2016, and December 26, 2019, 1,072 patients were randomly assigned (536 patients to CME and 536 patients to D2 dissection). In total, 995 patients (median age 61 years, 59% male) were included in the primary analysis (CME [n = 495] v D2 dissection [n = 500]). No significant differences were found between the groups in 3-year DFS (hazard ratio [HR], 0.74 [95% CI, 0.54 to 1.02]; P = .06; 86.1% in the CME group v 81.9% in the D2 group) or in 3-year OS (HR, 0.70 [95% CI, 0.43 to 1.16]; P = .17; 94.7% in the CME group v 92.6% in the D2 group). CONCLUSION This trial failed to find evidence of superior DFS outcome for CME compared with standard D2 lymph node dissection in primary surgical excision of right-sided colon cancer. Standard D2 dissection should be the routine procedure for these patients. CME should only be considered in patients with obvious mesocolic lymph node involvement.
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Affiliation(s)
- Junyang Lu
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiadi Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chenghai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lai Xu
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guannan Zhang
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zirui He
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yueming Sun
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yifei Feng
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaohui Du
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shidong Hu
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ziqiang Wang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Colorectal Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Zhong
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Aiwen Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Unit III & Ostomy Service, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Anlong Zhu
- Department of Colorectal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianmin Xu
- Colorectal Surgery Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Liang Kang
- Department of Colorectal Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jian Suo
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Haijun Deng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yingjiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China
| | - Kefeng Ding
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences; School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University and National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiangqian Su
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yi Xiao
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Yıldırım M, Kocabay A, Koca B, Saglam AI, Ozkan N. The effect of ileal resection length on postoperative complications and prognosis in right colon cancer. Langenbecks Arch Surg 2024; 409:206. [PMID: 38967821 PMCID: PMC11226531 DOI: 10.1007/s00423-024-03395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND There is a lack of literature on the length of the terminal ileum to be resected in right hemicolectomy for colon cancer. Therefore, we aimed to determine the mean ileal loop length and the effect of this variation on postoperative complications and long-term oncological outcomes in patients who underwent right hemicolectomy. METHODS Right hemicolectomy surgeries performed for colon cancer in a tertiary care hospital between January 2011 and December 2018 were retrospectively analyzed from a prospective database. Two patient groups were established based on the mean length of the resected ileum above and below 7 cm. The two groups were compared for clinicopathological data, postoperative complications, mortality, long-term overall survival (OS) and disease-free survival (DFS). The factors contributing to OS and DFS were analyzed. RESULTS The study included 217 patients. Body mass index (BMI) values were significantly higher in the ileum resection length > 7 cm group (p = 0.009). Pathological N stage, tumor diameter, and number of metastatic lymph nodes were significantly higher in the ileum resection length > 7 cm group (p = 0.001, p = 0.001, and p = 0.026, respectively). There was no significant difference for postoperative complication and mortality rates between the two groups. The mean follow-up period was 61.2 months (2-120) in all patients. The total number of deaths was 29 (11.7%) while the 60-month OS was 83.5% and 50-month DFS was 81.8%. There was no significant difference between the groups in terms of OS and DFS rates (p > 0.05). CONCLUSIONS Excessive resection of the distal ileum in right hemicolectomy does not provide any benefit in terms of prognosis and complications.The ileum resection length and values close to it in our study appear to be sufficient.
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Affiliation(s)
- Murat Yıldırım
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey.
| | - Asım Kocabay
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
| | - Bulent Koca
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
| | - Ali Ihsan Saglam
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
| | - Namık Ozkan
- Department of General Surgery, Faculty of Medicine, Gaziosmanpasa University, Sevki Erek Yerleskesi, Tokat, 60030, Turkey
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Balaban V, Mutyk M, Bondarenko N, Zolotukhin S, Sovpel O, Sovpel I, Zykov D, Rublevskiy I, Klochkov M, Prado AP, He M, Tsarkov P. Comparison of D2 vs D3 lymph node dissection for RIght COloN cancer (RICON): study protocol for an international multicenter open-label randomized controlled trial. Trials 2024; 25:438. [PMID: 38956698 PMCID: PMC11221103 DOI: 10.1186/s13063-024-08269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Colon cancer is a global health concern, ranking fifth in both new diagnoses and deaths among tumors worldwide. Surgical intervention remains the primary treatment for localized cases, with a historical evolution marked by a focus on short-term outcomes. While Japan pioneered radical tumor removal with a systematic categorization of lymph nodes (D1, D2, D3), the dissemination of Japanese practices to the West was delayed until 90th of last century. Discrepancies between Japanese D3 dissection and the CME with CVL principle persist, with variations in longitudinal margins and recommended procedures. Non-randomized trials indicate the superiority of D3 over D2, but a consensus is lacking. METHODS This prospective, international, multicenter, randomized controlled trial employs a two-arm, parallel-group, open-label design to rigorously compare the 5-year overall survival outcomes between D2 and D3 lymph node dissection in stage II-III right colon cancer. Building on prior studies, the trial aims to address existing knowledge gaps and provide a comprehensive evaluation of the outcomes associated with D3 dissection. The study population comprises patients with right colon cancer, ensuring a focused investigation into the specific context of this disease. The trial design emphasizes its global scope and collaboration across multiple centers, enhancing the generalizability of the findings. DISCUSSION This study's primary objective is to elucidate the potential superiority in 5-year overall survival benefits of D3 lymph node dissection compared to the conventional D2 approach in patients with stage II-III right colon cancer. By examining this specific subset of patients, the research aims to contribute valuable insights into optimizing surgical strategies for improved long-term outcomes. The trial's international and multicenter nature enhances its applicability across diverse populations. The outcomes of this study may inform future guidelines and contribute to the ongoing discourse surrounding the standardization of colon cancer surgery, particularly in the context of right colon cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT03200834. Registered on June 27, 2017.
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Affiliation(s)
| | - Mikhail Mutyk
- G.V. Bondar Republican Cancer Center, Donetsk, Ukraine
| | - Nikolay Bondarenko
- G.V. Bondar Republican Cancer Center, Donetsk, Ukraine
- M. Gorky Donetsk National Medical University, Donetsk, Ukraine
| | - Stanislav Zolotukhin
- G.V. Bondar Republican Cancer Center, Donetsk, Ukraine
- M. Gorky Donetsk National Medical University, Donetsk, Ukraine
| | - Oleg Sovpel
- G.V. Bondar Republican Cancer Center, Donetsk, Ukraine
- M. Gorky Donetsk National Medical University, Donetsk, Ukraine
| | - Igor Sovpel
- G.V. Bondar Republican Cancer Center, Donetsk, Ukraine
- M. Gorky Donetsk National Medical University, Donetsk, Ukraine
| | - Dmitriy Zykov
- G.V. Bondar Republican Cancer Center, Donetsk, Ukraine
| | - Igor Rublevskiy
- G.V. Bondar Republican Cancer Center, Donetsk, Ukraine
- M. Gorky Donetsk National Medical University, Donetsk, Ukraine
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Subramaniam S, Piozzi GN, Kim SH, Khan JS. Robotic approach to colonic resection: For some or for all patients? Colorectal Dis 2024; 26:1447-1455. [PMID: 38812078 DOI: 10.1111/codi.17046] [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: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
The robotic approach is rapidly gaining momentum in colorectal surgery. Its benefits in pelvic surgery have been extensively discussed and are well established amongst those who perform minimally invasive surgery. However, the same cannot be said for the robotic approach for colonic resection, where its role is still debated. Here we aim to provide an extensive debate between selective and absolute use of the robotic approach for colonic resection by combining the thoughts of experts in the field of robotic and minimally invasive colorectal surgery, dissecting all key aspects for a critical view on this exciting new paradigm in colorectal surgery.
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Affiliation(s)
- Sentilnathan Subramaniam
- Colorectal Surgery Unit, Department of General Surgery, Hospital Selayang, Selangor, Malaysia
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Seon-Hahn Kim
- Colorectal Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jim S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- University of Portsmouth, Portsmouth, UK
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Yu M, Cai Z, Zhou H, Fingerhut A, He Z, Xue P, Song H, Yang X, Cheng X, Zhang S, Xu X, Zhong H, Abuduaini N, Liu J, Wang X, Feng B. Natural orifice specimen extraction surgery versus small-incision assisted laparoscopic radical right hemicolectomy. Future Oncol 2023; 19:2641-2650. [PMID: 38108112 DOI: 10.2217/fon-2023-0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Conventional laparoscopic-assisted right hemicolectomy requires a small abdominal incision to extract the specimen, which becomes an important source of postoperative complications and impairs perioperative experience. Transvaginal natural orifice specimen extraction surgery (NOSES VIIIA) avoids this small incision by extracting the specimen through the vagina. Here we describe the design of a multicenter, open-label, parallel, noninferior, phase III randomized controlled trial (NCT05495048). The aim of this study is to confirm that the NOSES VIIIA procedure is not inferior to small-incision assisted right hemicolectomy in long-term oncological efficacy. A total of 352 female patients with right colon adenocarcinoma/high-grade intraepithelial neoplasia will be randomly assigned to the NOSES VIIIA arm and the small-incision arm in a 1:1 ratio. The primary end point of this trial is 3 year disease-free survival. Clinical Trial Registration: NCT05495048 (ClinicalTrials.gov).
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Affiliation(s)
- Mengqin Yu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhenghao Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Abraham Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zirui He
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Pei Xue
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Haiqin Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiao Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xi Cheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Sen Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ximo Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hao Zhong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Naijipu Abuduaini
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jingyi Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Bo Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Ryu S, Kitagawa T, Goto K, Okamoto A, Hara K, Nakabayashi Y. Intraoperative Double Navigation With Fluorescence and Holographic Guidance Using a Mixed Reality Technique for Splenic Flexure Cancer. Dis Colon Rectum 2023; 66:e1043-e1044. [PMID: 37493216 DOI: 10.1097/dcr.0000000000002907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi City, Japan
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Jarrett R, West NP. Macroscopic Evaluation of Colon Cancer Resection Specimens. Cancers (Basel) 2023; 15:4116. [PMID: 37627144 PMCID: PMC10452811 DOI: 10.3390/cancers15164116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Colon cancer is a common disease internationally. Outcomes have not improved to the same degree as in rectal cancer, where the focus on total mesorectal excision and pathological feedback has significantly contributed to improved survival and reduced local recurrence. Colon cancer surgery shows significant variation around the world, with differences in mesocolic integrity, height of the vascular ligation and length of the bowel resected. This leads to variation in well-recognised quality measures like lymph node yield. Pathologists are able to assess all of these variables and are ideally placed to provide feedback to surgeons and the wider multidisciplinary team to improve surgical quality over time. With a move towards complete mesocolic excision with central vascular ligation to remove the primary tumour and all mechanisms of spread within an intact package, pathological feedback will be central to improving outcomes for patients with operable colon cancer. This review focusses on the key quality measures and the evidence that underpins them.
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Affiliation(s)
| | - Nicholas P. West
- Pathology & Data Analytics, Leeds Institute of Medical Research, St. James’s University Hospital, School of Medicine, University of Leeds, Leeds LS9 7TF, UK
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Nguyen NH, Vu XV, Nguyen VQ, Nguyen TH, Du Nguyen H, Luong TH, Nguyen TK, Nguyen HH. Bach Mai Procedure for complete mesocolic excision, central vascular ligation, and D3 lymphadenectomy in total laparoscopic right hemicolectomy: a prospective study. World J Surg Oncol 2023; 21:140. [PMID: 37147674 PMCID: PMC10161467 DOI: 10.1186/s12957-023-03026-5] [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: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/07/2023] Open
Abstract
PURPOSE Total laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL), and D3 lymphadenectomy is still the most challenging colon procedures for gastrointestinal surgeons. We herein report the technical details and our preliminary experience of Bach Mai Procedure - a novel-combining (cranial, medial to lateral, and caudal) approach with early resection of the terminal ileum. METHODS The dissection stage was central vascular isolation and ligation by a combined multiple approaches in the following four steps: cranial approach, dissecting along the inferior aspect of pancreatic isthmus to reveal the middle colic vessels and the anterior aspect of the superior mesentery vein and then exposed the right gastroepiploic vein and the trunk of Henle; medial-to-lateral approach, exposing the surgical axis - the superior mesenteric vascular axis and then early resection of the terminal ileum to open the dissection from the bottom up; and caudal approach, radical ligation of the ileocecal artery and right colic artery (central vascular ligation), lymph node dissection (D3 lymphadenectomy), and resecting the Toldt fascia of the colon to release the entire right colon from the abdominal wall. RESULTS In 12 months, there were 32 cases of primary right-sided colon malignancies that have undergone tLRHD3, CME/CVL based on the Bach Mai Procedure. In 3 cases (9.4%), the tumor site was hepatic flexure. The median of lymph node number (LNN) was 38, with the maximum number which was 101. No serious postoperative complications (grade 3 or higher) neither inhospital mortality was detected. CONCLUSION This Bach Mai procedure, a novel-combining approach with early resection of the terminal ileum, is technically feasible and safe for tLRHD3, CME/CVL. Further investigations and follow-up must be proceeded to evaluate the long-term outcomes of our technique.
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Affiliation(s)
- Ngoc Hung Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Xuan Vinh Vu
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Vu Quang Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - The Hiep Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Huy Du Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam.
| | - Thanh Khiem Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Ham Hoi Nguyen
- Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
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Smalbroek BP, Smits AB, Khan JS. Safe oncological and standardised ("SOS") right hemicolectomy for colon cancer. Tech Coloproctol 2023; 27:169-170. [PMID: 36645583 DOI: 10.1007/s10151-022-02749-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Affiliation(s)
- B P Smalbroek
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - J S Khan
- Department of Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
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Intracorporeal Anastomosis Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: An Observational Cohort Study. World J Surg 2023; 47:785-795. [PMID: 36635607 DOI: 10.1007/s00268-022-06834-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Current studies did not draw definitive conclusions on comparison of intracorporeal anastomosis (ICA) with extracorporeal anastomosis (ECA) in laparoscopic right colectomy. Whether the intraperitoneal contamination induced by ICA can result in higher risk of postoperative abdominal infection remains unclear. This study was aimed to compare the short-term outcomes, especially the risk of abdominal infection after ICA versus ECA. METHODS This was an observational cohort study as a secondary analysis of a randomized controlled trial (RCT)-RELARC trial (NCT02619942). The patients enrolled in the RELARC trial were diagnosed with primary colon adenocarcinoma without distant metastasis and underwent radical laparoscopic right colectomy between Jan 2016 and Dec 2019. In our study the patients who converted to open surgery in RELARC trial were excluded. The short-term outcomes were compared between ICA and ECA. The primary endpoint was abdominal infection. The inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) was used for adjusting the potential confounders. RESULTS This study enrolled 975 patients with 119 patients undergoing ICA and 856 patients undergoing ECA. The incidence of abdominal infection was higher in ICA group (9.2% versus 1.5%, RR from IPTW = 5.7 (95%CI: 2.6-12.6), P < 0.001) as well as the incidence of wound infection (14.3% vs 3.3%, RR from IPTW = 5.0 (95%CI: 2.9-8.6), P < 0.001). ICA was associated with higher incidence of Clavien-Dindo (CD) grade I and II complications (CD-I: 15.1% versus 6.8%, RR from IPTW = 2.4 (95%CI: 1.5-3.9), P < 0.001; CD-II: 26.9% versus 8.2%, RR from IPTW = 3.6 (95%CI: 2.5-5.1), P < 0.001) but similar incidence of CD-III ~ IV complications compared to ECA (3.4% vs 2.1%, RR from IPTW = 1.2 (95%CI: 0.4-4.0), P = 0.73). In ICA group, choosing another incision rather than lengthening main port site decreased the incidence of wound infection although without statistical significance (17.3% (14/81) versus 7.9% (3/38), crude RR = 2.2 (95%CI: 0.7-7.2), P = 0.17). CONCLUSION ICA is likely to be associated with higher risk of abdominal infection and CD-I ~ II complications.
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Long-term oncologic outcome of D3 lymph node dissection for clinical stage 2/3 right-sided colon cancer. Int J Colorectal Dis 2023; 38:42. [PMID: 36790520 DOI: 10.1007/s00384-023-04310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To investigate oncologic outcomes including overall survival and disease-free survival depending on the extent of lymphadenectomy (D3 versus D2) by comparing D3 and D2 lymphadenectomy in patients with clinical stage 2/3 right colon cancer. METHODS Consecutive series of patients who underwent radical resection for right colon cancer at our three hospitals between January 2015 and June 2018 were retrospectively analyzed. Study cohorts were divided into two groups: D3 group and D2 group. Oncologic, pathologic, and perioperative outcomes of the two groups were compared. RESULTS A total of 295 patients (167 in the D2 group and 128 in the D3 group) were included in this study. Patients' characteristics showed no significant difference between the two groups. The median number of harvested lymph nodes was significantly higher in the D3 group than in the D2 group. The rate of complications was not significantly different between the two groups except for chyle leakage, which was more frequent in the D3 group. Five-year disease-free survival was 90.2% (95% CI: 84.8-95.9%) in the D3 group, which was significantly (p = 0.028) higher than that (80.5%, 95% CI: 74-87.5%) in the D2 group. There was no significant difference in overall survival between the two groups. CONCLUSION Our results indicate that D3 lymphadenectomy is associated with more favorable 5-year disease-free survival than D2 lymphadenectomy for patients with stage 2/3 right-sided colon cancer. D3 lymphadenectomy might improve oncologic outcomes in consideration of the recurrence rate.
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Sun R, Zhang G, Sun X, Niu B, Zhou J, Cong L, Qiu H, Lin G, Wu B, Xiao Y. Comparing the techniques and outcomes of laparoscopic transverse colectomy to laparoscopic hemicolectomy in mid-transverse colon cancer resection. Front Surg 2023; 9:1012947. [PMID: 36684238 PMCID: PMC9852304 DOI: 10.3389/fsurg.2022.1012947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/07/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction The mid-transverse colon cancer is relatively uncommon in all colon cancers and the optimal surgical approach of mid-transverse colon cancer remains debatable. Aim and Objectives Our study aimed to depict the techniques and outcomes of laparoscopic transverse colectomy in one single clinical center and compare this surgical approach to traditional laparoscopic right hemicolectomy and laparoscopic left hemicolectomy. Method This was a retrospective cohort study of patients with mid-transverse colon cancer in one single clinical center from February 2012 to October 2020. The enrolled patients were divided into two groups undergoing laparoscopic transverse colectomy and laparoscopic right/left hemicolectomy, respectively. The intraoperative, postoperative complications, oncological outcomes and functional outcomes were compared between the two groups. The primary endpoint was disease free survival (DFS). Results The study enrolled 70 patients with 40 patients undergoing laparoscopic transverse colectomy and 30 patients undergoing laparoscopic hemicolectomy. The intraoperative accidental hemorrhage and multiple organ resection occurred similarly in the two groups. In transverse colectomy, caudal-to-cephalic approach was likely to harvest more lymph nodes although require more operation time than cephalic-to-caudal approach (23.1 ± 14.3 vs. 13.4 ± 5.4 lymph nodes, P = 0.004; 184.3 ± 37.1 min vs. 146.3 ± 44.4 min, P = 0.012). The laparoscopic transverse colectomy was marginally associated with lower incidence of overall postoperative complications and shorter postoperative hospital stay although without statistical significance (8(20.0%) vs. 12(40.0%), P = 0.067; 7(5-12) vs. 7(5-18), P = 0.060). The 3-year DFS showed no significant difference (3-year DFS 89.7% in transverse colectomy vs. 89.9% in hemicolectomy, P = 0.688) between the two groups. The alternating consistency of defecation occurred significantly less after laparoscopic transverse colectomy than laparoscopic hemicolectomy (15(51.7%) vs. 20(80.0%), P = 0.030). Conclusion The laparoscopic transverse colectomy is technically feasible with satisfactory oncological and functional outcomes for mid-transverse colon cancer. Performing the caudal-to-cephalic approach might be more advantageous in lymphadenectomy.
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Romano G, Di Buono G, Galia M, Agnello F, Anania G, Guerrieri M, Milone M, Silecchia G, Buscemi S, Agrusa A. Role of preoperative CT angiography with multimodality imaging reconstruction to perform laparoscopic Complete Mesocolic Excision (CME) and Central Vascular Ligation (CVL) in right-sided colon cancer: Is it really useful? A prospective clinical study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:209-216. [PMID: 36002353 DOI: 10.1016/j.ejso.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/01/2022] [Accepted: 08/10/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The concept of complete mesocolic excision (CME) and central vascular ligation (CVL) in right colonic resections appears to improve the oncological outcomes. The highest rate of complications reported in the literature in patients undergoing CME is related to difficult surgical manuevers and intraoperative bleeding due to the central vascular dissection. METHODS We used preoperative findings obtained with the CT angiography, multiplanar reformation (MPR), maximum intesity projection (MIP) and 3D volume rendering (VR) technique to verify if this preoperative radiological assessment had significant benefits regarding the difficulty of dissection of the embryological planes, the identification of vascular structures and central lymph nodes with reduction in mean operative time, intraoperative complications and better short-term outcomes versus standard contrast enhanced CT scan. We also have administered a questionnaire to investigate the subjective responses on the degree of difficulty of the surgical procedure both by the surgical team expert in CME and by a group of young surgeons. RESULTS Statistical analysis showed that overall operative time was significant shorter in patients underwent to radiological assessment (224,5 min; range 160-300 versus 252,6 min; range 200-340; p-value 0.023) with a significant lower rate of intraoperative complication (2.7% versus 4.2%; p-value 0.043). No differences were reported with respect to blood loss, conversion rate, anastomotic leakage or other surgical results. Analysis of the questionnaire underlined a progressive awareness of the correspondence between the radiological imaging and the surgical field. CONCLUSION The possibility of identifying the characteristics and course of the vascular structures along the axis of the superior mesenteric vessels certainly increases the surgeon's knowledge of the operating field, making him more confident with surgical maneuvers and significantly reducing the duration of the operating time and intraoperative complications.
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Affiliation(s)
- Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
| | - Massimo Galia
- Department of Radiology, University of Palermo, Palermo, Italy
| | | | - Gabriele Anania
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Milone
- Department of Surgical Specialties, University "Federico II" of Naples, Naples, Italy
| | - Gianfranco Silecchia
- Division of General Surgery & Bariatric Center of Excellence IFSO EC, Department of Medico-Surgical Sciences and Biothecnologies, Sapienza University of Rome, Latina, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Giani A, Bertoglio CL, Mazzola M, Giusti I, Achilli P, Carnevali P, Origi M, Magistro C, Ferrari G. Mid-term oncological outcomes after complete versus conventional mesocolic excision for right-sided colon cancer: a propensity score matching analysis. Surg Endosc 2022; 36:6489-6496. [PMID: 35028735 DOI: 10.1007/s00464-021-09001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The correct extent of mesocolic dissection for right-sided colon cancer (RCC) is still under debate. Complete mesocolic excision (CME) has not gained wide diffusion, mainly due to its technical complexity and unclear oncological superiority. This study aims to evaluate oncological outcomes of CME compared with non-complete mesocolic excision (NCME) during resection for I-III stage RCC. METHOD Prospectively collected data of patients who underwent surgery between 2010 and 2018 were retrospectively analysed. 1:1 Propensity score matching (PSM) was used to balance baseline characteristics of CME and NCME patients. The primary endpoint of the study was local recurrence-free survival (LRFS). The two groups were also compared in terms of short-term outcomes, distant recurrence-free survival, disease-free survival, and overall survival. RESULTS Of the 444 patients included in the study, 292 were correctly matched after PSM, 146 in each group. The median follow-up was 45 months (IQR 33-63). Conversion rate, complications, and 90-day mortality were comparable in both groups. The median number of lymph nodes harvested was higher in CME patients (23 vs 19, p = 0.034). 3-year LRFS rates for CME patients was 100% and 95.6% for NCME (log-rank p = 0.028). At 3 years, there were no differences between the groups in terms of overall survival, distant recurrence-free survival, and disease-free survival. CONCLUSION Our PSM cohort study shows that CME is safe, provides a higher number of lymph nodes harvested, and is associated with better local recurrence-free survival.
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Affiliation(s)
- Alessandro Giani
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Camillo Leonardo Bertoglio
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Irene Giusti
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Pietro Achilli
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Pietro Carnevali
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Matteo Origi
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Carmelo Magistro
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
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Feng X, Wang H, Feng B, Chen X, Yi X, Zhang Q, Li E, Zhuang Y, Li H, Lu X, Chen Z, Wan J, Liao W, Wang J, Deng H, Chen C, Diao D. Risk factors of central area lymph nodes metastasis for guiding optimal right colon cancer surgery: A retrospective multicenter study.. [DOI: 10.21203/rs.3.rs-1991182/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Background: D3 or CME lymphadenectomy for right colon cancer (RCC) with lymph nodes metastasis (LNM) is strongly recommended but the anatomical landmark remains controversial. Central LNM predicted poor prognosis in RCC and determined the extent of lymphadenectomy. Methods: Data for 1712 RCC patients treated with D3/CME lymphadenectomy were reviewed. These patients had been treated in 9 centers. A total of 1023 RCC patients were enrolled in the derivation cohort while 689 patients were enrolled in the validation cohort. Results: The overall central LNM incidence was 12.58% (215/1712). In the derivation cohort, univariate and multivariate cox regression analyses revealed that preoperative N staging based on CT scan (OR=7.85, 95% CI, 4.53-14.51, p<0.001), tumor differentiation (OR=0.53, 95% CI, 0.33-0.86, p=0.01) and intraoperative view of tumor movability (OR=0.53, 95% CI, 0.33-0.86, p=0.02) were significant independent factors. Areas under receiver-operating characteristic curves (AUC) for assessing central LNM in the derivation and validation cohorts were 0.802 and 0.750, respectively. The risk-scoring system for patients with RCC was also established. A score of 0 points was the optimal cut-off value for central LNM. Compared to patients in the low-risk group, patients in the high-risk group exhibited worse overall survival outcomes (p<0.001).Conclusions: The established model can be used for preoperative assessment of the risk of central LNM in RCC patients, and for determining the landmark for D3/CME lymphadenectomy, therefore might contribute to decreased therapeutic complications and improved clinical outcomes.
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Affiliation(s)
- Xiaochuang Feng
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | | | | | | | - Xiaojiang Yi
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | | | - En Li
- Meizhou City People's Hospital
| | | | - Hongming Li
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | - Xinquan Lu
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | - Zhaoyu Chen
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | - Jin Wan
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | - Weilin Liao
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | - Jiahao Wang
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
| | - Haijun Deng
- Nanfang Hospital, Southern Medical, University
| | - Chuangqi Chen
- The First Affiliated Hospital of Sun Yat-sen University
| | - Dechang Diao
- Guangdong Provincal Hospital of Chinese Medicine, University of Chinese Medicine
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Consensus statements on complete mesocolic excision for right-sided colon cancer-technical steps and training implications. Surg Endosc 2022; 36:5595-5601. [PMID: 35790593 PMCID: PMC9283340 DOI: 10.1007/s00464-021-08395-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
Background CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways. Methods Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus. Results Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme. Conclusions Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08395-0.
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Fletcher J, Miskovic D. The Mesentery in Complete Mesocolic Excision. Clin Colon Rectal Surg 2022; 35:288-297. [PMID: 35966980 PMCID: PMC9365457 DOI: 10.1055/s-0042-1743430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The following article summarizes technical aspects of how to operate in the mesentery during complete mesocolic excision (CME). Increasingly, CME is being adopted and as such it is important to establish the anatomical basis of the techniques involved. This review thus serves to provide that foundation and explains the surgical techniques built on it.
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Affiliation(s)
- Jordan Fletcher
- Department of Colorectal Surgery, St. Mark's Hospital, London, United Kingdom
| | - Danilo Miskovic
- Department of Colorectal Surgery, St. Mark's Hospital, London, United Kingdom
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Testa DC, Mazzola L, di Martino G, Cotellese R, Selvaggi F. Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study. ANZ J Surg 2021; 92:132-139. [PMID: 34636465 PMCID: PMC9293306 DOI: 10.1111/ans.17264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND To examine the outcome of patients treated with complete mesocolic excision (CME) with central vascular ligation (CVL) after conventional and laparoscopic surgery. METHODS We retrospectively evaluated stage I-IV colon adenocarcinoma patients treated by the same surgeon (L.M.) from 2013 to 2018. Postoperative complications, recurrences and survival are assessed. RESULTS Fifty-one patients (M/F: 24/27) underwent laparoscopic right hemicolectomy with CME (L-CME) or open CME (O-CME) plus CVL. Tumour location was the caecum in 39.2% of cases, the transverse in 23.5%, the hepatic colonic flexure in 21.5%, and the ascending colon in 15.6%. Twenty-four patients underwent L-CME while 27 underwent O-CME. More than 15 harvested lymphnodes are reported in 74.1% of O-CME patients and in 66.7% of L-CME patients (p = 0.562). Postoperative complications occurred in 7 O-CME and 5 L-CME patients, respectively (p = 0.669). Three-year overall survival, including stage IV, was of 75% versus 77.8% for L-CME and O-CME patients, respectively, while for stage I-III, was of 88.9% vs. 80% in L-CME and O-CME, respectively (p = 0.440). The median follow-up was of 2.43 years. CONCLUSION CME with CVL is a meticulous, complex but feasible technique. In our experience, oncological results in terms of recurrences and overall survival, after conventional and laparoscopic CME plus CVL, are comparable. Patients with stage I-III colon adenocarcinoma have a better prognostic trend especially when more than 15 lymphnodes are removed. The respect of oncological radicality and the correct indication to minimally invasive surgery are the undiscussed key outcome variables.
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Affiliation(s)
- Domenica Carmen Testa
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Lorenzo Mazzola
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.,Unit of General Surgery, "Renzetti" Hospital, Lanciano, Italy
| | - Giuseppe di Martino
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Roberto Cotellese
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.,Fondazione Villa Serena per la Ricerca, Pescara, Italy
| | - Federico Selvaggi
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.,Unit of General Surgery, "Renzetti" Hospital, Lanciano, Italy
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20
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Anania G, Davies RJ, Bagolini F, Vettoretto N, Randolph J, Cirocchi R, Donini A. Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis. Tech Coloproctol 2021; 25:1099-1113. [PMID: 34120270 PMCID: PMC8419145 DOI: 10.1007/s10151-021-02471-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/30/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The introduction of complete mesocolic excision (CME) for right colon cancer has raised an important discussion in relation to the extent of colic and mesenteric resection, and the impact this may have on lymph node yield. As uncertainty remains regarding the usefulness of and indications for right hemicolectomy with CME and the benefits of CME compared with a traditional approach, the purpose of this meta-analysis is to compare the two procedures in terms of safety, lymph node yield and oncological outcome. METHODS We performed a systematic review of the literature from 2009 up to March 15th, 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two hundred eighty-one publications were evaluated, and 17 met the inclusion criteria and were included. Primary endpoints analysed were anastomotic leak rate, blood loss, number of harvested lymph nodes, 3- and 5-year oncologic outcomes. Secondary outcomes were operating time, conversion, intraoperative complications, reoperation rate, overall and Clavien-Dindo grade 3-4 postoperative complications. RESULTS In terms of safety, right hemicolectomy with CME is not inferior to the standard procedure when comparing rates of anastomotic leak (RR 0.82, 95% CI 0.38-1.79), blood loss (MD -32.48, 95% CI -98.54 to -33.58), overall postoperative complications (RR 0.82, 95% CI 0.67-1.00), Clavien-Dindo grade III-IV postoperative complications (RR 1.36, 95% CI 0.82-2.28) and reoperation rate (RR 0.65, 95% CI 0.26-1.75). Traditional surgery is associated with a shorter operating time (MD 16.43, 95% CI 4.27-28.60) and lower conversion from laparoscopic to open approach (RR 1.72, 95% CI 1.00-2.96). In terms of oncologic outcomes, right hemicolectomy with CME leads to a higher lymph node yield than traditional surgery (MD 7.05, 95% CI 4.06-10.04). Results of statistical analysis comparing 3-year overall survival and 5-year disease-free survival were better in the CME group, RR 0.42, 95% CI 0.27-0.66 and RR 0.36, 95% CI 0.17-0.56, respectively. CONCLUSIONS Right hemicolectomy with CME is not inferior to traditional surgery in terms of safety and has a greater lymph node yield when compared with traditional surgery. Moreover, right-sided CME is associated with better overall and disease-free survival.
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Affiliation(s)
- G Anania
- Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - R J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - F Bagolini
- Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy
| | - N Vettoretto
- Montichiari Surgery, ASST Spedali Civili, Brescia, Italy
| | - J Randolph
- Georgia Baptist College of Nursing. Mercer University, Atlanta, GA, USA
| | - R Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Azienda Ospedaliera Di Terni, 05100, Terni, Italy.
| | - A Donini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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21
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Zhou L, Diao D, Ye K, Feng Y, Yi X, Tong W, Xu J, Su H, Wang Y, He L, He Z, Xu Z, Lu X, Lin J, Zhang J, Xue P, Zhang D, Li H, Ma J, Kang W, Yang X, Li J, Cai T, Lu A, Liu S, Sun J, Zhang S, Zheng M, Wang Q, Sun Y, Feng B. The Medial Border of Laparoscopic D3 Lymphadenectomy for Right Colon Cancer: Results from an Exploratory Pilot Study. Dis Colon Rectum 2021; 64:1286-1296. [PMID: 34310517 DOI: 10.1097/dcr.0000000000002046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Opinions vary on the medial border of D3 lymphadenectomy for right colon cancer. Most surgeons place the medial border along the left side of the superior mesenteric vein, but some consider the left side of the superior mesenteric artery as the medial border. OBJECTIVES This study investigated the clinical outcomes of laparoscopic D3 lymphadenectomy for right colon cancer with the medial border along the left side of superior mesenteric artery. DESIGN This was a retrospective study. SETTINGS The study was conducted in specialized colorectal cancer department of 5 tertiary hospitals. PATIENTS Patients receiving laparoscopic D3 lymphadenectomy for right colon cancer from January 2013 to December 2018 were included. MAIN OUTCOME MEASURES After propensity score matching, 307 patients receiving laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery were assigned to the superior mesenteric artery group and 614 patients were assigned to the superior mesenteric vein group. Univariate, multivariate, and Kaplan-Meier analyses were performed to assess the clinical data. RESULTS The short-term outcomes were similar between the 2 groups; however, the superior mesenteric artery group had a higher rate of chylous leakage (p < 0.001). More lymph nodes were harvested from the superior mesenteric artery group than from the superior mesenteric vein group (p = 0.001). The number (p = 0.005) of metastatic lymph nodes and the lymph node ratio (p = 0.041) in main nodes were both higher in the superior mesenteric artery group. The 2 groups had similar long-term survival, but the superior mesenteric artery group tended to show better disease-free survival in patients with stage disease III (p = 0.056). LIMITATIONS This was a retrospective, nonrandomized study. CONCLUSION Laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery, except for a higher rate of chylous leakage, had short-term outcomes comparable to the superior mesenteric vein group. The superior mesenteric artery group tended to achieve better disease-free survival in patients with stage III disease, but further study is required to better elucidate differences in these approaches because risks/benefits do exist.
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Affiliation(s)
- Leqi Zhou
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dechang Diao
- Department of Gastrointestinal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kai Ye
- Department of oncological surgery, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yifei Feng
- Department of Colorectal, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaojiang Yi
- Department of Gastrointestinal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weihua Tong
- Gastric and Intestinal Department of the First Hospital of Jilin University, Changchun, China
| | - Jianhua Xu
- Department of oncological surgery, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hao Su
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wang
- Department of Colorectal, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang He
- Gastric and Intestinal Department of the First Hospital of Jilin University, Changchun, China
| | - Zirui He
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziwei Xu
- Department of Colorectal, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinquan Lu
- Department of Gastrointestinal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianan Lin
- Department of oncological surgery, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jiaxin Zhang
- Gastric and Intestinal Department of the First Hospital of Jilin University, Changchun, China
| | - Pei Xue
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongsheng Zhang
- Department of Colorectal, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongming Li
- Department of Gastrointestinal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wengui Kang
- Department of oncological surgery, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiao Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianwen Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianyi Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiguo Lu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shiguang Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sen Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quan Wang
- Gastric and Intestinal Department of the First Hospital of Jilin University, Changchun, China
| | - Yueming Sun
- Department of Colorectal, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Kwak HD, Chung JS, Ju JK, Lee SY, Kim CH, Kim HR. Proper surgical extent for clinical Stage I right colon cancer. J Minim Access Surg 2021; 18:224-229. [PMID: 35046161 PMCID: PMC8973476 DOI: 10.4103/jmas.jmas_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Pre-operative evaluation identifying clinical-stage affects the decision regarding the extent of surgical resection in right colon cancer. This study was designed to predict a proper surgical resection through the prognosis of clinical Stage I right colon cancer. Patients and Methods: We included patients who were diagnosed with clinical and pathological Stage I right-sided colon cancer, including appendiceal, caecal, ascending, hepatic flexure and proximal transverse colon cancer, between August 2010 and December 2016 in two tertiary teaching hospitals. Patients who underwent open surgeries were excluded because laparoscopic surgery is the initial approach for colorectal cancer in our institutions. Results: Eighty patients with clinical Stage I and 104 patients with pathological Stage I were included in the study. The biopsy reports showed that the tumour size was larger in the clinical Stage I group than in the pathological Stage I group (3.4 vs. 2.3 cm, P < 0.001). Further, the clinical Stage I group had some pathological Stage III cases (positive lymph nodes, P = 0.023). The clinical Stage I group had a higher rate of distant metastases (P = 0.046) and a lower rate of overall (P = 0.031) and cancer-specific survival (P = 0.021) than the pathological Stage I group. Compared to pathological Stage II included in the period, some of the survival curves were located below the pathological Stage II, but there was no statistical difference. Conclusion: The study results show that even clinical Stage I cases, radical resection should be considered in accordance with T3 and T4 tumours.
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Affiliation(s)
- Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, South Korea
| | - Jun Seong Chung
- Department of Surgery, Chonnam National University Hospital, Gwangju, South Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, South Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Gwangju, South Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Gwangju, South Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University College of Medicine, Gwangju, South Korea
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23
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Mesenteric closure with polymer-ligating clips after right colectomy with complete mesocolic excision for cancer and mesentery-based ileocolic resection for Crohn's disease. Tech Coloproctol 2021; 25:1079-1084. [PMID: 34268652 DOI: 10.1007/s10151-021-02493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
Mesenteric closure following right colectomy remains controversial and, following the advent of laparoscopic surgery, many surgeons do not routinely close the mesentery after colorectal resection. Nevertheless, especially after the introduction of operations such as right colectomy with complete mesocolic excision and ileocolic resections with extensive mesentery removal for Crohn's disease, the wide mesenteric defect resulting from the dissections can certainly expose the patients to complications such as internal hernias or volvuli. In general, mesenteric closure requires intracorporeal suturing. We describe a simple technique for the closure of the mesentery after surgical resection using polymer-ligating clips. This novel technique seems to minimize the time, effort and risk inherent to the procedure, even after large mesenteric excisions.
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24
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Feng X, Li H, Lu X, Yi X, Wan J, Liao W, Wang J, Ke Y, Tan P, Chen J, Liu T, Hong X, Diao D. Regional lymph nodes distribution pattern in central area of right-sided colon cancer: in-vivo detection and the update on the clinical exploration. Am J Cancer Res 2021; 11:2095-2105. [PMID: 34094671 PMCID: PMC8167669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023] Open
Abstract
Distribution of regional lymph nodes (LNs) is decisive for the lymphadenectomy boundary in radical resection of right-sided colon cancer (RCC). Currently, the data of LNs in central area remains ambiguous and scarce. Herein we aim to provide a more detailed anatomical research on LNs surrounding the superior mesenteric vessels for RCC and investigated the metastasis rate. In this study, Carbon Nanoparticles (CNs) and Indocyanine Green (ICG) were used for regional LNs mapping by preoperative colonoscopic tattooing (PCT) and we laparoscopically observed the stained LNs distribution pattern. Lastly, 143 RCC patients who received a "superior mesenteric artery (SMA)-oriented" hemicolectomy were included to calculate the probability of LNs metastasis in our target area. 27 patients diagnosed as RCC (mean age 58.04 years, 17 male) were included. 14 patients underwent CNs injection and 13 patients consented to the ICG, while 4 cases suffered from imaging failure. The unequal number of the regional LNs located between SMV and SMA was detected in 22 cases (81.48%), posterior to SMV area in 6 cases (22.22%), and anterior to SMA in 16 cases (59.26%), respectively. The presence of LNs posterior to SMV was associated with the crossing pattern of ileocolic artery (χ2 = 4.24, P = 0.039). The probability of LNs metastasis in the above areas (target areas) was 2.10% (3/143). In conclusion, right-hemi colon-draining lymphatic vessels anteriorly/posteriorly traversed the SMV and arrived at the surface of SMA near the middle colonic artery (MCA) level, which highlights the potential need of removing mesenteric tissue in our target area on lymphatic resection.
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Affiliation(s)
- Xiaochuang Feng
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Hongming Li
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Xinquan Lu
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Xiaojiang Yi
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Jin Wan
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Weilin Liao
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Jiahao Wang
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Yisen Ke
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Ping Tan
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Jialiang Chen
- Department of Radiology, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Tianwen Liu
- Department of Gastroenterology, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Xiaoyan Hong
- Department of Anesthesiology, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
| | - Dechang Diao
- Department of Colorectal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese MedicineNo. 111, Dade Rd, Yuexiu, Guangzhou 510120, Guangdong, China
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25
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Mazzarella G, Muttillo EM, Picardi B, Rossi S, Muttillo IA. Complete mesocolic excision and D3 lymphadenectomy with central vascular ligation in right-sided colon cancer: a systematic review of postoperative outcomes, tumor recurrence and overall survival. Surg Endosc 2021; 35:4945-4955. [PMID: 33977376 DOI: 10.1007/s00464-021-08529-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In right-sided colon cancer surgery, currently there is a great deal of discussion and debate regarding complete mesocolic excision (CME) versus conventional right hemicolectomy (CRH) on postoperative outcomes and oncological results. Our aim was to perform a systematic review of the short- and long-term outcomes of CME to standardize surgical approach in patients with right-sided colon cancer. METHODS A systematic review was performed examining available data on randomized and non-randomized studies evaluating the role of CME and D3 lymphadenectomy in the treatment of right-sided colon cancer, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. RESULTS After literature search, 919 studies have been recorded, 110 studies underwent full-text reviews and 30 studies met inclusion criteria. The total number of CME procedures was 5931. Postoperative complications was reported in 28 studies with pooled overall complications of 1.88% for CME surgery. Six studies reported 0% of overall postoperative complications and they demonstrated a low incidence of complications following CME procedure. Anastomotic leak was reported in 27 studies with pooled proportion of 0.92% after CME resections. There were 16 papers reporting overall survival following CME procedure, with a mean of 85% of patients survived at 5 years. Mean 5-year overall survival was 93.05% in stage I patients, 89.76% in stage II patients and 79.65% in stage III patients. Local and distant recurrence were included in 21 studies, reporting tumor recurrence rate of 12.25% following CME. 5-year tumor recurrence was 5.8% in stage I patients, 7.68% in stage II patients and 15.69% in stage III patients. CONCLUSIONS CME does not increase the risk of postoperative complications and significantly improves the long-term oncological impact. Prospective multicentre studies results are needed to verify if CME could be considered standard surgery for right colon cancer.
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Affiliation(s)
- Gennaro Mazzarella
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy. .,Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Edoardo Maria Muttillo
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy.,Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Biagio Picardi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Stefano Rossi
- Department of General and Emergency Surgery, San Filippo Neri Hospital, Rome, Italy
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Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:881-892. [PMID: 33170319 DOI: 10.1007/s00384-020-03797-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) has introduced a promising surgical approach for treatment of right colon cancer. However, benefits of CME are still a matter of debate. We conducted a systematic review and meta-analysis to assess safety and long-term outcomes of CME versus conventional right hemicolectomy (CRH). METHODS We systematically searched MEDLINE, the Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase for retrieving studies comparing CME with CRH in right colon cancer. After data extraction from the included studies, meta-analysis was performed to compare postoperative complications, anastomotic leakage, 30-day mortality, number of lymph node yield, disease-free survival (DFS), and overall survival (OS). RESULTS Eight studies met the inclusion criteria with a total of 1871 patients enrolled. No difference was observed in postoperative complications (OR 1.13, 95% CI 0.88-1.47, p = 0.34). CME was associated with significantly higher number of lymph nodes retrieved (MD 9.17, CI 4.67-13.68, p < 0.001). CME also improved 3-year OS (OR 1.57, 95% CI 1.17-2.11, p = 0.003), 5-year OS (OR 1.41, 95% CI 1.06-1.89, p = 0.02), and 5-year DFS (OR 1.99, 95% CI 1.29-3.07, p = 0.002). A sub-group analysis for patients with stage III colon cancer showed no significant impact of CME on 3-year and 5-year OS (OR 2.47, 95% CI 0.86-7.06, p = 0.09; OR 1.23, 95% CI 0.78-1.94, p = 0.38). CONCLUSION Although with limited evidence, CME shows similar postoperative complication rates and an improved survival outcome compared with CRH.
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Kang CB, Li XB, Hou S, Zhang J, Chi XQ, Shan HF, Zhang QJ, Liu TJ. The Application of Core Needle Biopsy Through the Trocar Hole in the Surgical Operation of Endoscopically Unresectable Giant Colon Polyps: A Systematic Review Study. Adv Ther 2021; 38:2662-2672. [PMID: 33864202 DOI: 10.1007/s12325-021-01635-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/23/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The study aimed to investigate the application of core needle biopsy through the trocar hole during surgery on endoscopically unresectable giant colon polyps. METHODS The clinical data of 51 patients with endoscopically unresectable giant colon polyps from May 2016 to May 2020 were retrospectively analyzed. The primary observational outcomes were two comparative analyses of pathologic results, using the kappa index: comparison of the pathologic results from the preoperative colonoscopy and the postoperative pathologic results and comparison of the intraoperative pathologic results from core needle biopsy of the intestinal wall and the postoperative pathologic results. The secondary observational outcomes were duration of needle biopsy, operation duration, volume of intraoperative hemorrhage, rate of postoperative wound infection, rate of abdominal cavity infection, length of stay, and number and positivity of lymph node dissections after laparoscopic radical resection of colon cancer. RESULTS Poor consistency was found between the preoperative (colonoscopy) and postoperative pathologic results, with kappa = 0.222 (i.e., kappa < 0.4), P < 0.05. However, good consistency was found between the intraoperative (core needle biopsy) and postoperative pathologic results, with kappa = 0.923 (i.e., kappa ≥ 0.75), P < 0.05. The postoperative pathologic results were as follows: 7 cases of adenomatous polyps of the colon, 12 cases of low-grade intraepithelial neoplasia, 12 cases of high-grade intraepithelial neoplasia, and 25 cases of invasive colon cancer. There was no incision infection, no abdominal cavity infection or formation of an abdominal abscess, no anastomotic leakage, and no death for any of the 51 patients. Postoperative complications occurred in two cases (3.92%). CONCLUSION Biopsy through the trocar hole during laparoscopic surgery produced highly accurate pathologic results and was a fast, safe, and effective diagnostic method. Pathologic results from intraoperative biopsy could accurately determine the nature of colon polyps and provide a basis for choosing an appropriate surgical scheme.
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Wang X, Huang S, Lu X, Huang Y, Chi P. Incidence of and Risk Factors for Gastroepiploic Lymph Node Involvement in Patients with Cancer of the Transverse Colon Including the Hepatic Flexure. World J Surg 2021; 45:1514-1525. [PMID: 33475804 DOI: 10.1007/s00268-020-05933-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To define the incidence of gastroepiploic lymph node (GLN) metastasis in patients with cancer of the transverse colon, including the hepatic flexure, and to identify the preoperative predictors of GLN involvement in a large-volume center in China. METHODS This retrospective monocentric cross-sectional study respected the STROBE statement. Of 3208 consecutive patients who underwent colon cancer resection, a total of 371 patients with cancer of the transverse colon including the hepatic flexure who underwent complete mesocolic excision and GLN resection in our center were retrospectively reviewed between November 2010 and November 2017. Logistic regression was performed to identify predictors of GLN metastasis. Endoscopic obstruction was defined as a luminal obstruction of the colon severe enough to prevent the colonoscope from passing beyond the tumor regardless of the presenting symptoms. RESULTS The GLN involvement rate was 4.0 (2.0-6.1)%. Patients who had GLN involvement had a significantly higher rate of endoscopic obstruction (P = 0.030), higher rate of signet ring adenocarcinoma or lymphovascular invasion (P < 0.05), higher preoperative CEA level (P = 0.037), more advanced pN stage (P < 0.001) and more advanced M stage (P = 0.003) than the patients without GLN involvement. ROC curve analyses showed that the cutoff value for CEA was 17.0 ng/ml (46.7% sensitivity, 84.3% specificity, P = 0.037) for the prediction of GLN metastasis. Multivariate analysis showed that endoscopic obstruction, signet ring adenocarcinoma, a CEA level ≥17 ng/ml and M1 stage were independently correlated with the GLN metastasis. CONCLUSION The incidence rate of GLN metastasis was low. To the best of our knowledge, the present study was the first to evaluate the preoperative predictors of GLN metastasis. Combinations of predictive factors may be useful for stratifying patients at high risk of GLN metastasis.
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Affiliation(s)
- Xiaojie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Shenghui Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Xingrong Lu
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Ying Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People's Republic of China
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Kim JS, Baek SJ, Kwak JM, Kim J, Kim SH, Ji WB, Kim JS, Hong KD, Um JW, Kang SH, Lee SI, Min BW. Impact of D3 lymph node dissection on upstaging and short-term survival in clinical stage I right-sided colon cancer. Asian J Surg 2021; 44:1278-1282. [PMID: 33752988 DOI: 10.1016/j.asjsur.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND D3 lymph node dissection is becoming the standard procedure for the treatment of advanced right colon cancer and has shown increasing evidence of its oncologic benefit. However, a clear indication for its application is lacking and data on this topic is unsatisfactory. Thus, the necessity for D3 lymph node dissection in clinical stage I right colon cancer remains controversial. METHODS We retrospectively analyzed data from clinical stage I right colon cancer patients who underwent radical surgery at three hospitals of Korea university medical center between January 2015 and June 2018. We compared surgical complications and short-term oncologic outcomes between D2 and D3 lymph node dissections in these patients. RESULTS Among 512 patients, 122 (23.8%) were clinical stage I. Of these, 88 and 34 patients received D2 and D3 lymph node dissection, respectively. There were no statistically significant differences in clinicopathologic variables and surgical outcomes between the two groups. Upstaging occurred in 16 patients (47.1%) in the D3 group and 23 patients (26.1%) in the D2 group. There were four recurrences in the D2 group but no recurrence in the D3 group. Log-rank tests showed no statistically significant difference in disease-free survival rates between the two groups (p = 0.210). CONCLUSION There was no significant difference in disease-free survival rates between D2 and D3 lymph node dissection in clinical stage I right colon cancer patients. However, recurrence occurred in the D2 group. Efforts to improve the accuracy of clinical staging are required and more studies with better quality are needed.
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Affiliation(s)
- Ji-Seon Kim
- Division of Colon and Rectal Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Se-Jin Baek
- Division of Colon and Rectal Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jin Kim
- Division of Colon and Rectal Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Seon-Hahn Kim
- Division of Colon and Rectal Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Woong Bae Ji
- Division of Colon and Rectal Surgery, Korea University Ansan Hospital, Ansan, South Korea.
| | - Jung Sik Kim
- Division of Colon and Rectal Surgery, Korea University Ansan Hospital, Ansan, South Korea
| | - Kwang Dae Hong
- Division of Colon and Rectal Surgery, Korea University Ansan Hospital, Ansan, South Korea
| | - Jun Won Um
- Division of Colon and Rectal Surgery, Korea University Ansan Hospital, Ansan, South Korea
| | - Sang Hee Kang
- Division of Colon and Rectal Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Sun Il Lee
- Division of Colon and Rectal Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Byung Wook Min
- Division of Colon and Rectal Surgery, Korea University Guro Hospital, Seoul, South Korea
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Mathis K. Laparoscopic complete mesocolic excision: safe for right colon cancer? Lancet Oncol 2021; 22:293-294. [PMID: 33587895 DOI: 10.1016/s1470-2045(21)00002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
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Xu L, Su X, He Z, Zhang C, Lu J, Zhang G, Sun Y, Du X, Chi P, Wang Z, Zhong M, Wu A, Zhu A, Li F, Xu J, Kang L, Suo J, Deng H, Ye Y, Ding K, Xu T, Zhang Z, Zheng M, Xiao Y. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol 2021; 22:391-401. [PMID: 33587893 DOI: 10.1016/s1470-2045(20)30685-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Whether extended lymphadenectomy for right colon cancer leads to increased perioperative complications or improves survival is still controversial. This trial aimed to compare the efficacy and safety of complete mesocolic excision (CME) versus D2 dissection in laparoscopic right hemicolectomy for patients with right colon cancer. This article reports the early safety results from the trial. METHODS This randomised, controlled, phase 3, superiority, trial was done at 17 hospitals in nine provinces of China. Eligible patients were aged 18-75 years with histologically confirmed primary adenocarcinoma located between the caecum and the right third of the transverse colon, without evidence of distant metastases. Central randomisation was done by means of the Clinical Information Management-Central Randomisation System via block randomisation (block size of four). Patients were randomly assigned (1:1) to CME or D2 dissection during laparoscopic right colectomy. Central lymph nodes were dissected in the CME but not in the D2 procedure. Neither investigators nor patients were masked to their group assignment but the quality control committee were masked to group assignment. The primary endpoint was 3-year disease-free survival, but the data for this endpoint are not yet mature; thus, only the secondary outcomes-intraoperative surgical complications and postoperative complications within 30 days of surgery, graded according to the Clavien-Dindo classification, mortality (death from any cause within 30 days of surgery), and central lymph node metastasis rate in the CME group only-are reported in this Article. This early analysis of safety was preplanned. The outcomes were analysed according to a modified intention-to-treat principle (excluding patients who no longer met inclusion criteria after surgery or who did not have surgery). This study is registered with ClinicalTrials.gov, NCT02619942. Study recruitment is complete, and follow-up is ongoing. FINDINGS Between Jan 11, 2016, and Dec 26, 2019, 1072 patients were enrolled and randomly assigned. After exclusion of 77 patients, 995 patients were included in the modified intention-to-treat population (495 in the CME group and 500 in the D2 dissection group). The postoperative surgical complication rate was 20% (97 of 495 patients) in the CME group versus 22% (109 of 500 patients) in the D2 group (difference, -2·2% [95% CI -7·2 to 2·8]; p=0·39); the frequency of Clavien-Dindo grade I-II complications were similar between groups (91 [18%] vs 92 [18%], difference, -0·0% [95% CI -4·8 to 4·8]; p=1·0) but Clavien-Dindo grade III-IV complications were significantly less frequent in the CME group than in the D2 group (six [1%] vs 17 [3%], -2·2% [-4·1 to -0·3]; p=0·022); no deaths occurred in either group. Of the intraoperative complications, vascular injury was significantly more common in the CME group than in the D2 group (15 [3%] vs six [1%], difference, 1·8 [95% CI 0·04 to 3·6]; p=0·045). Metastases in the central lymph nodes were detected in 13 (3%) of 394 patients who underwent central lymph node biopsy in the CME group; no patient had isolated metastases to central lymph nodes. INTERPRETATION Although the CME procedure might increase the risk of intraoperative vascular injury, it generally seems to be safe and feasible for experienced surgeons. FUNDING The Capital Characteristic Clinical Project of Beijing and the Chinese Academy of Medical Sciences.
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Affiliation(s)
- Lai Xu
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Xiangqian Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zirui He
- Department of General Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chenghai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, China
| | - Junyang Lu
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Guannan Zhang
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Yueming Sun
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaohui Du
- Department of General Surgery, Chinese General Hospital of People's Liberation Army, Beijing, China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fujian, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Zhong
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Aiwen Wu
- Department of Unit III & Ostomy Service, Gastrointestinal Cancer Centre, Peking University Cancer Hospital and Institute, Beijing, China
| | - Anlong Zhu
- Department of Colorectal Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianmin Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Kang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian Suo
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Haijun Deng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yingjiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China
| | - Kefeng Ding
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention (Ministry of Education), The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tao Xu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China; School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University and National Clinical Research Centre for Digestive Diseases, Beijing, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Xiao
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China.
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Siddiqi N, Stefan S, Jootun R, Mykoniatis I, Flashman K, Beable R, David G, Khan J. Robotic Complete Mesocolic Excision (CME) is a safe and feasible option for right colonic cancers: short and midterm results from a single-centre experience. Surg Endosc 2021; 35:6873-6881. [PMID: 33399993 PMCID: PMC8599208 DOI: 10.1007/s00464-020-08194-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) for right colon cancers has traditionally been an open procedure. Surgical adoption of minimal access CME remains limited due to the technical challenges, training gaps and lack of level-1 data for proven benefits. Currently there is limited published data regarding the clinical results with the use of robotic CME surgery. Aim To report our experience, results and techniques, highlighting a clinical and oncological results and midterm oncological outcomes for robotic CME. AIM To report our experience, results and techniques, highlighting a clinical and oncological results and midterm oncological outcomes for robotic CME. METHODS All patients undergoing standardised robotic CME technique with SMV first approach between January 2015 and September 2019 were included in this retrospective review of a prospectively collected database. Patient demographics, operative data and clinical and oncological outcomes were recorded. RESULTS Seventy-seven robotic CME resections for right colonic cancers were performed over a 4-year period. Median operative time was 180 (128-454) min and perioperative blood loss was 10 (10-50) ml. There were 25 patients who had previous abdominal surgery. Median postoperative hospital stay was 5 (3-18) days. There was no conversion to open surgery in this series. Median lymph node count was 30 (10-60). Three (4%) patients had R1 resection. There was one (1%) local recurrence in stage III disease and 4(5%) distal recurrence in stage II and stage III. There was no 30- or 90-day mortality. Three-year disease-free survival was 100%, 91.7% and 92% for stages I, II and III, respectively. Overall survival was 94%. CONCLUSIONS Robotic CME is feasible, effective and safe. Good oncological results and improved survival are seen in this cohort of patients with a standardised approach to robotic CME.
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Affiliation(s)
- Najaf Siddiqi
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - Samuel Stefan
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK.,University of Portsmouth, Portsmouth, UK
| | - Ravish Jootun
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - Ioannis Mykoniatis
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - Karen Flashman
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - Richard Beable
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - Gerald David
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - Jim Khan
- Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Portsmouth, Portsmouth, UK. .,University of Portsmouth, Portsmouth, UK.
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Anania G, Arezzo A, Davies RJ, Marchetti F, Zhang S, Di Saverio S, Cirocchi R, Donini A. A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision. Int J Colorectal Dis 2021; 36:1609-1620. [PMID: 33644837 PMCID: PMC8280018 DOI: 10.1007/s00384-021-03891-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery. METHODS PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios. RESULTS Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, - 0.41-1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI - 0.20-6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD - 0.55, 95% CI - 0.57-1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups. CONCLUSIONS Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.
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Affiliation(s)
- Gabriele Anania
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Alberto Arezzo
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Richard Justin Davies
- grid.24029.3d0000 0004 0383 8386Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Marchetti
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Shu Zhang
- grid.452404.30000 0004 1808 0942Department of Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Salomone Di Saverio
- grid.18147.3b0000000121724807Department of General Surgery, University of Insubria, Varese, Italy
| | - Roberto Cirocchi
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
| | - Annibale Donini
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
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Response to Comment on "Efficacy and Safety of Complete Mesocolic Excision in Patients With Colon Cancer: Three-year Results From a Prospective, Nonrandomized, Double-blind, Controlled Trial". Ann Surg 2020; 274:e755-e756. [PMID: 33234780 DOI: 10.1097/sla.0000000000004273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tejedor P, Francis N. Can complete mesocolon excision be considered the treatment of choice in right hemicolectomy for cancer? Cir Esp 2020; 99:255-257. [PMID: 32345441 DOI: 10.1016/j.ciresp.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
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Kwak HD, Ju JK, Yeom SS, Lee SY, Kim CH, Kim YJ, Kim HR. Is radical surgery for clinical stage I right-sided colon cancer relevant? A retrospective review. Ann Surg Treat Res 2020; 98:139-145. [PMID: 32158734 PMCID: PMC7052394 DOI: 10.4174/astr.2020.98.3.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 02/07/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection. Methods Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution. Results During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors. Conclusion For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.
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Affiliation(s)
- Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Seung-Seop Yeom
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Athanasiou C, Pitt J, Malik A, Crabtree M, Markides GA. A Systematic Review and Meta-Analysis of Single-Incision Versus Multiport Laparoscopic Complete Mesocolic Excision Colectomy for Colon Cancer. Surg Innov 2019; 27:235-243. [PMID: 31854262 DOI: 10.1177/1553350619893232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. Methods. MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. Results. Seven studies (3 randomized) with a total number of 1344 patients were included (546 SILS CME and 798 MPL CME). No difference was found in anastomotic leakage (odds ratio [OR] = 0.79 [0.31 to 2.03]; P = .63), number of lymph nodes (weighted mean difference [WMD] = 0.85 [-0.97 to 2.66]; P = .36), hospital stay (WMD = 0.01 [-0.19 to 0.20]; P = .96), overall survival (hazard ratio [HR] = 1.19 [0.29 to 4.80]; P = .81), and disease-free survival (HR = 1.30 [0.30 to 5.61]; P = .72). Skin incision was shorter in SILS CME group (WMD = -3.02 [-3.25 to -2.80]; P < .00001) but with no difference in pain reported in postoperative day 1 (standardized mean difference [SMD] = -0.21 [-0.50 to 0.09]; P = .17) or day 2 (SMD = 0.16 [-0.52 to 0.84]; P = .64). Conclusions. SILS CME, although technically more demanding, has equivalent short- and long-term outcomes when compared with MPL CME. Potential benefits in cosmesis or postoperative pain need to be further explored by high-quality randomized controlled trials.
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Affiliation(s)
- Christos Athanasiou
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - James Pitt
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Arshad Malik
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Michael Crabtree
- Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Georgios A Markides
- Royal Blackburn Teaching Hospital, East Lancashire Teaching Hospitals, Blackburn, UK
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Ma L, Liu C, Mei J, Chen LQ. Successful Cervical Esophageal Reconstruction Using Gastric Conduit Without Gastroepiploic Artery. Ann Thorac Surg 2019; 107:e409-e410. [DOI: 10.1016/j.athoracsur.2018.09.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/04/2018] [Accepted: 09/21/2018] [Indexed: 10/27/2022]
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Fingerhut A, Tzu-Liang Chen W, Boni L, Uranues S. Complete mesocolic excision for colonic cancer. MINERVA CHIR 2019; 74:148-159. [DOI: 10.23736/s0026-4733.18.07777-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Yozgatli TK, Aytac E, Ozben V, Bayram O, Gurbuz B, Baca B, Balik E, Hamzaoglu I, Karahasanoglu T, Bugra D. Robotic Complete Mesocolic Excision Versus Conventional Laparoscopic Hemicolectomy for Right-Sided Colon Cancer. J Laparoendosc Adv Surg Tech A 2019; 29:671-676. [PMID: 30807257 DOI: 10.1089/lap.2018.0348] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Robotic technique has been proposed to overcome the limitations of laparoscopic surgery. In this study, we aimed at determining whether robotic complete mesocolic excision (CME) for right-sided colon cancer can be safe and effective as conventional laparoscopic right hemicolectomy (CLRH). Materials and Methods: Between February 2015 and September 2017, patients undergoing robotic right CME and CLRH with curative intent for right-sided colon cancer were included. Patient characteristics, short-term and histopathological outcomes were compared between the groups. Results: Ninety-six patients (robotic, n = 35) were included in this study. The operative time (286 ± 77 versus 132 ± 40 minutes, P = .0001) was significantly longer in the robotic group. There were no conversions in either group. No significant differences existed between the groups regarding the mean estimated blood loss, time to first flatus, length of hospital stay (6 ± 3 versus 6 ± 3 days, P = .64), and follow-up times (robotic 15 ± 8 versus laparoscopic 16 ± 10 months P = .11). Overall complication rates (n = 10 [29%] versus n = 15 [25%], P = .67) were similar. In the robotic group, vascular injury occurred in 2 patients, and both were repaired robotically. The mean number of harvested lymph nodes was significantly higher (41 ± 12 versus 33 ± 10, P = .04) and length between the vascular tie and colonic wall was longer (13 ± 3.5 versus 11 ± 3, P = .02) in the robotic group. Conclusion: Although robotic right CME seems equally safe to CLRH in terms of short-term morbidity, future prospective randomized trials are needed to define its role for treatment of right colectomy.
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Affiliation(s)
- Tahir K Yozgatli
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Erman Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Volkan Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Onur Bayram
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Gurbuz
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
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41
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Willaert W, Cosyns S, Ceelen W. Biology-Based Surgery: The Extent of Lymphadenectomy in Cancer of the Colon. Eur Surg Res 2018; 59:371-379. [DOI: 10.1159/000494831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 11/19/2022]
Abstract
The progression of colon cancer (CC) involves hematogenous and lymphatic spread to locoregional lymph nodes (LN), distant LN, and metastatic sites including the liver. The biological mechanisms that govern CC progression remain elusive. The Halsted model assumes an orderly, stepwise progression from the primary tumor to nearby nodes, henceforth to anatomically more distant nodes, and ultimately to distant organs. The Fisher model, on the other hand, regards the release of metastatic cells as early and essentially random events. The underlying biology has important implications for the ideal extent of surgery: when the Fisher model is correct, efforts to remove apical (central), extramesenteric, or para-aortic LN are unlikely to affect the oncological outcome. Recent data from phylogenetic studies suggest that cancer cell populations differ genetically among different LN stations and from distant metastases. Circulating tumor cells and other liquid biomarkers can be detected in the circulation of patients with early-stage disease. Local recurrence in CC is uncommon, and it is associated with a high risk of systemic progression and poor survival. Clinical studies comparing standard colectomy with extensive surgery (high ligation of the inferior mesenteric artery, complete mesocolic excision, D3 dissection, and para-aortic or extramesenteric node dissection) show that these techniques increase the LN count, while any beneficial effect on the risk of local recurrence or disease-free survival is at present uncertain due to the lack of controlled trials. Ongoing randomized trials comparing extensive vs. standard surgery for CC will generate important answers.
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Salem JF, Gummadi S, Marks JH. Minimally Invasive Surgical Approaches to Colon Cancer. Surg Oncol Clin N Am 2018; 27:303-318. [PMID: 29496091 DOI: 10.1016/j.soc.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Colon cancer remains the most common abdominal visceral malignancy affecting both men and women in America. Open colectomy has been the standard of care for colon cancer patients the past 100 years; although highly effective, the major trauma associated with it has a significant morbidity rate and represents a large operation for patients to recover from. Minimally invasive colon surgery was developed as a new and alternative option, and surgeons aim to continue to make it simpler, more reproducible, and easier to teach and learn. We describe herein the current state of minimally invasive colorectal surgery for colon cancer and compare it with open surgery to offer insights to future directions.
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Affiliation(s)
- Jean F Salem
- Division of Colorectal Surgery, Lankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA 19096, USA
| | - Sriharsha Gummadi
- Division of Colorectal Surgery, Lankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA 19096, USA
| | - John H Marks
- Division of Colorectal Surgery, Lankenau Medical Center, 100 East Lancaster Avenue, Wynnewood, PA 19096, USA.
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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Variations of Gastrocolic Trunk of Henle and Its Significance in Gastrocolic Surgery. Gastroenterol Res Pract 2018; 2018:3573680. [PMID: 29977286 PMCID: PMC6011069 DOI: 10.1155/2018/3573680] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/02/2018] [Indexed: 12/22/2022] Open
Abstract
Due to the increasing incidence of gastrointestinal (GI) tumors, more and more importance is attached to radical resection and patients' survival, which requires adequate extent of resection and radical lymph node dissection. Blood vessels around the gastrointestinal tract, as anatomical landmarks for tumor resection and lymph node dissection, play a key role in the successful surgery and curative treatment of gastrointestinal tumors. In the isolation of subpyloric area or hepatic flexure of the colon for gastrectomy or right hemicolectomy, lymph node dissection and ligation are often performed at the head of the pancreas and superior mesenteric vein, during which even a minor inadvertent error may lead to unwanted bleeding. Among these blood vessels, the venous system composed of Henle's trunk and its tributaries is the most complex, which has a direct influence on the outcome and postoperative recovery of the patients. There are many variations of Henle's trunk, with complicated courses and various locations, attracting more and more researchers to study it and tried to analyze the influence of its variations on gastrointestinal surgeries. We characterized various variants and tributaries of Henle's trunk using autopsy, vascular casting, 3D CT reconstruction, intraoperative anatomy, and Hisense CAS system and summarized and analyzed the tributaries of Henle's trunk, to determine its influence on GI surgeries.
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45
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Negoi I, Beuran M, Hostiuc S, Negoi RI, Inoue Y. Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis. Sci Rep 2018; 8:4184. [PMID: 29520096 PMCID: PMC5843657 DOI: 10.1038/s41598-018-22641-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/27/2018] [Indexed: 12/16/2022] Open
Abstract
The surgeon dissecting the base of the mesenterium, around the superior mesenteric vein (SMV) and artery, is facing a complex tridimensional vascular anatomy and should be aware of the anatomical variants in this area. The aim of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, with impact in colon and pancreatic resections. We conducted a systematic search in PubMed/MEDLINE and Google Scholar databases up to March 2017. Forty-five studies, involving a total of 6090 specimens were included in the present meta-analysis. The pooled prevalence of the ileocolic, right colic and middle colic arteries was 99.8%, 60.1%, and 94.6%, respectively. The superior right colic vein and Henle trunk were present in 73.9%, and 89.7% of specimens, respectively. In conclusion, the infra-pancreatic anatomy of the superior mesenteric vessels is widely variable. We propose the term Henle trunk to be used for any venous confluence between gastric, pancreatic and colic veins, which drains between the inferior border of the pancreas and up to 20 mm downward on the right-anterior aspect of the SMV. The term gastrocolic trunk should not be synonymous, but a subgroup of the Henle trunk, together with to gastropancreatocolic, gastropancreatic, or colopancreatic trunk.
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Affiliation(s)
- Ionut Negoi
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania.
- Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania.
| | - Mircea Beuran
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
- Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Sorin Hostiuc
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
- Department of Legal Medicine and Bioethics, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | | | - Yosuke Inoue
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Bao F, Deng ZG, Wang D, Xian-yu JB, Li GQ, Xiang CH, Xiang RC, Zhi X. Factors influencing lymph node skip metastasis in colorectal cancer: a retrospective study. ANZ J Surg 2017; 88:770-774. [PMID: 29194915 DOI: 10.1111/ans.14268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Feng Bao
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
| | - Zhi-gang Deng
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
| | - Dong Wang
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
| | - Jian-bo Xian-yu
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
| | - Guo-qiang Li
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
| | - Chun-hua Xiang
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
| | - Rong-chao Xiang
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
| | - Xing Zhi
- Department of General Surgery; Mianyang Central Hospital; Mianyang, Sichuan China
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Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, Yin M, Yang X, Wang S, Ye Y. Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Colorectal Dis 2017; 19:962-972. [PMID: 28949060 DOI: 10.1111/codi.13900] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
AIM The application of complete mesocolic excision (CME) in colon cancer is controversial. We performed a meta-analysis to compare the safety, quality and effect of CME with non-complete mesocolic excision (NCME) in patients with colon cancer. METHOD We searched PubMed, ScienceDirect, the Cochrane Library and Scopus to identify studies comparing CME with NCME in colon cancer. We focused on three study outcome areas: safety (operation time, blood loss, complications, mortality); quality (large bowel length, distance from the tumour to the high vascular tie, area of mesentery, total lymph nodes); and effect (long-term survival). RESULTS A total of 8586 patients from 12 studies were included in the meta-analysis. CME was associated with greater intra-operative blood loss [weighted mean difference (WMD) 79.87, 95% CI: 65.88-93.86], more postoperative surgical complications (relative risk 1.23, 95% CI: 1.08-1.40), longer large bowel resection (WMD 47.06, 95% CI: 10.49-83.62), greater distance from the tumour to the high vascular tie (WMD 17.51, 95% CI: 15.16-19.87), larger area of mesentery (WMD 36.09, 95% CI: 18.06-54.13) and more lymph nodes (WMD 6.13, 95% CI: 1.97-10.28) than NCME. CME also had positive effects on 5-year survival [hazard ratio (HR) 0.33, 95% CI: 0.13-0.81], 3-year survival (HR 0.58, 95% CI: 0.39-0.86) and 3-year survival for Stage III disease (HR 0.69, 95% CI: 0.60-0.80) compared with NCME. CONCLUSION Limited evidence suggests that CME is a more effective strategy for improving specimen quality and survival but with a higher complication rate.
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Affiliation(s)
- C Wang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - Z Gao
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing, China
| | - K Shen
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - Z Shen
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - K Jiang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - B Liang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - M Yin
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - X Yang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - S Wang
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
| | - Y Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Beijing, China
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