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Abstract: Total mesorectal excision (TME) improves local recurrence rates and so it is accepted as the gold standard surgical method for locally advanced rectal cancer surgery. Based on these experiences, the concept of embryonic plane dissection was translated to surgery of colon cancer as complete mesocolic excision (CME) and central vascular lig...
Context in source publication
Context 1
... anatomy of right colic vein (RCV), superior RCV, gastrocolic trunk and middle colic vein (MCV) has too many variations (28,29). The confluence of right gastroepiploic vein, superior RCV and anterior superior pancreaticoduodenal vein which is known as "gastrocolic trunk of Henle" present in 46-70% cases (27,30) (Figure 3). Study of Yamaguchi et al. (31) showed that MCV has two variations. ...
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Background:
To evaluate the effect of magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) and tumor deposits (TDs) on distant metastasis and long-term survival after surgery for stage III rectal cancer based on the relationship between the bottom of the tumor and peritoneal reflection.
Methods:
A retrospective study w...
Citations
... TME involves resection of the rectum and mesorectum, along with its supplying vessels and lymph nodes, as an intact specimen. This dissection, which follows the embryological development of the rectum, has been shown to improve outcomes and decrease local recurrences [4,5]. As a result, TME has become the standard treatment for rectal cancers. ...
Background
This study aims to evaluate and compare the safety and efficacy of robotic and laparoscopic complete mesocolic excision (CME) for patients diagnosed with right colon cancer. The study also examined 5-year survival rates to determine the outcomes of these procedures.
Methods
Patients who underwent CME for right-sided colon cancer between 2014 and 2021 were included in the current study. Group differences of age, body mass index, operation time, bleeding amount, total harvested lymph nodes and post-operation hospital stay were analyzed by the Mann-Whitney U test. Group differences of sex, American Society of Anesthesiology, and TNM stage were analyzed by the Chi-squared test. Disease-free survival and overall survival were assessed using Kaplan-Meier curves and compared using the log-rank Mantel-Cox test.
Results
From 109 patients, 74 of them were 1:1 propensity score matched and used for analysis. Total harvested lymph node (p = < 0.001) and estimated blood loss (p = 0.031) were found to have statistically significant between the groups. We found no statistically significant difference between the groups in terms of disease-free and overall survival (p = 0.27 and 0.86, respectively), and the mortality rate was 9.17%, with no deaths directly attributed to the surgery.
Conclusions
Our study shows that minimally invasive surgery is a feasible option for CME in right colon cancers, with acceptable overall survival rates. Although the robotic approach resulted in a higher lymph node yield, there was no significant difference in survival rates between the robotic and laparoscopic approaches. Further randomized trials are needed to determine the clinical significance of both approaches.
... As a result, CME has gained increased notoriety over recent years and has become the technique of choice among colorectal surgical centers [4,5]. Moreover, the number of studies investigating the efficacy of CME is growing steadily [6,7]. CME is performed by sharp dissection of the embryological mesocolic plane to create an intact envelope with high tie of colonic arteries and veins called central vascular ligation (CVL), ensuring maximum removal of lymphatic vessels and lymph nodes [8]. ...
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.
... In extended right colectomy, the resection includes the distal transverse colon and sometimes the splenic flexure, and ligating the ileocolic, right colic, and middle colic vessels are involved. The technical details of CME and CC were described in our previous papers [16,19,20]. The major important difference between CME and CC techniques is the level of ligation of main vascular structures. ...
Background
Oncologic outcomes after complete mesocolic excision (CME) in colon cancer are under investigation. The aim of our study was to compare CME and conventional colectomy (CC) in terms of pathological and oncological outcomes for right colon cancer and to evaluate the impact of lymph node metastasis around the vascular tie on survival.Methods
Consecutive patients with right colon cancer who had CME or CC between January 2011 and August 2018 at two specialized centers in Turkey were included. Statistical analyses were performed with respect to demographic characteristics, operative and pathologic outcomes, harvested and metastatic lymph nodes around the vascular tie (LNVT), recurrences, and survival.ResultsThere were 91 patients in the CME group (58 males, mean age 64 ± 16 years) and 192 patients in the CC group (96 males, mean age 66 ± 14 years). The mean number of harvested lymph nodes (CME: 42 ± 15 vs CC: 34 ± 13, p = 0.01) and LNVT were higher in the CME group (CME: 3.2 ± 2.2 vs CC: 2.4 ± 1.6, p = 0.001). LNVT metastases were 7.7% and 8.3% in the CME and CC groups, respectively (p = 0.85). Three-year overall and disease-free survival rates were 96.4% and 90.9% in the CME group and 90.4% and 87.6% in the CC group in stage I–III patients (p > 0.05). In stage III patients, the 3-year overall survival (92.5% vs 63.5%, p = 0.03) and disease-free survival (85.6% vs 52.1%, p = 0.008) were significantly better in LNVT-negative patients than in LNVT-positive patients.ConclusionLNVT metastasis seems to be the key factor associated with poor disease-free and overall survival in right colon cancer regardless of the radicality of surgery.
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.
