#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Complete mesocolic excision during right hemicolectomy


Authors: V. Procházka 1;  A. Zetelova 1;  T. Grolich 1;  L. Frola 2;  Z. Kala 1
Authors‘ workplace: Chirurgická klinika LF Masarykovy univerzity Brno a FN Brno-Bohunice, přednosta: prof. MUDr. Z. Kala, CSc. 1;  Patologicko-anatomický ústav LF Masarykovy univerzity Brno a FN Brno-Bohunice, přednosta: doc. MUDr. L. Křen, Ph. D. 2
Published in: Rozhl. Chir., 2016, roč. 95, č. 10, s. 359-364.
Category: Original articles

Overview

Introduction:
Complete mesocolic excision (CME) ensures the removal of all sentinel and regional lymph nodes during colon cancer surgery. For right-sided hemicolectomy it is essential to dissect the wall of vena mesenterica superior, which increases the risk of injuring surrounding organs. So far, no randomized studies comparing long-term oncological results of standard right hemicolectomy and hemicolectomy with CME have been published.

Method:
83 patients operated for colon carcinoma in 2014 and 2015 were included in this study, all of them undergoing right-sided hemicolectomy using laparotomy access. The standard procedure was done in 63 cases and hemicolectomy with CME was done in 20 cases. We compared the incidence of complications, and the characteristics and descriptions of obtained specimens evaluated by a pathologist for both groups.

Results:
The operation times of right-sided hemicolectomies with CME was longer by 20 minutes on average. The incidence of postoperative complications was similar in both groups. Pancreatic fistula in the group of patients undergoing right-sided hemicolectomy with CME was an unusual complication; the fistula was healed through conservative treatment. Comparing the resecate parameters, we found no significant differences in the lengths of the resected terminal ileum. But the length of the resected colon was significantly longer for the CME technique (median 42 cm versus 22 cm). The incidence of lymph node metastases was similar in both groups. However, the total number of removed lymph nodes in the group with CME was significantly higher (median 23).

Conclusion:
Right-sided hemicolectomy with complete mesocolic excision offers the removal of more lymph nodes than the standard technique. The central vascular ligation technique elongates the operation time and may be associated with more intraoperative injuries. Introduction of the concept of complete mesocolic excision is derived from an effort to standardize the surgical technique for colon cancer resection.

Key words:
right-sided hemicolectomy − complete mesocolic excision − colon cancer −lymphadenectomy


Sources

1. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Eng J Med 2006;355:1114−23.

2. Heald RJ. The “Holy plane“ of rectal surgery. J R Soc Med 1988;81:503−8.

3. Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome. Colorectal Dis 2009;11:354−65.

4. Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Disease-free survical after complete mesocolic excison compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 2015;16:161−8.

5. Hovorková E, Hadži-Nikolov D, Ferko A, et al. Problematika stanovení bezpečných resekčních okrajů u karcinomu rekta. Rozhl Chir 2014;93:92−9.

6. West NP, Morris EJ, Rotimi O, et al. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 2008;9:857−65.

7. Yao H, Liu Y. Re-examination of the standardization of colon cancer surgery. Gastroenterol Rep 2013;1:113−8.

8. Feng B, Ling TL, Lu AG, et al. Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer. Surg Endosc 2014;28:477−83.

9. Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Short-term outcomes after complete mesocolic excision compared with ‚conventional‘ colonic cancer surgery. Br J Surg 2016;103:581−9.

10. Bertelsen CA, Bols B, Ingeholm P, et al. Lymph node metastases in the gastrocolic ligament in patients with colon cancer. Dis Colon Rectum 2014;57:839−45.

11. Škrovina M, Straka M, Holášková E, et al. Karcinom tlustého střeva – zhodnocení komplikací a rizik plánovaných resekčních výkonů. Rozhl Chir 2014;93:311−6.

12. Japanese Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus 7th edn. Tokyo, Kanehara & Co. Ltd 2006.

13. West NP, Kobayashi H, Takashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 2012;30:1763−69.

14. Toyota S, Ohta H, Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 1995;38:705−11.

15. Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer staging manual. 7 th edn. New York, Springer 2010.

16. Culligan K, Walsh S, Dunne C, et al. The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilisation. Ann Surg 2014;260:1048−56.

17. Killeen S, Mannion M, Devaney A, et al. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Colorectal Dis 2014;16:577−94.

18. Iversen LH, Ingeholm P, Gőgenur I, et al. Major reduction in 30-day mortality after elective colorectal cancer surgery: a nationwide population-based study in Denmark 2001−2011. Ann Surg Oncol 2014;21:2267−73.

19. West NP, Hohenberger W, Weber K, et al. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010;28:272−8.

20. West NP, Sutton KM, Ingeholm P, et al. Improving the quality of colon cancer surgery through a surgical education program. Dis Colon Rectum 2010;53:1594−603.

Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#