Clinical outcome of laparoscopic complete mesocolic excision in the treatment of right colon cancer

Yong Wang, Chuan Zhang, Dongsheng Zhang, Zan Fu, Yueming Sun, Yong Wang, Chuan Zhang, Dongsheng Zhang, Zan Fu, Yueming Sun

Abstract

Background: This study aimed to investigate the clinical outcome of complete mesocolic excision (CME) with a caudal-to-cranial medial approach in the treatment of right colon cancer.

Methods: The clinical data of 172 patients who underwent laparoscopic CME for right colon cancer and were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2010 to April 2015 were retrospectively analyzed. The 3-year disease-free survival (DFS) and overall survival (OS) in relation to gender, age, history of abdominal surgery, tumor size, complications, and tumor-node-metastasis (TNM) classification were analyzed using the Kaplan-Meier survival curves.

Results: A total of 172 patients with 94 males and 78 females were included. The average surgical time was 113.5 ± 34.4 min, blood loss was 74.2 ± 28.1 mL, and the number of lymph nodes retrieved was 23.3 ± 9.2. No readmission or death occurred within 30 days after surgery. Postoperative complications occurred in 16.3% of the patients, which included wound infection (3 patients), chylous fistula (22 patients), anastomotic leakage (1 patient), anastomotic bleeding (1 patient), and lung infection (1 patient). The 3-year DFS and OS were 81.7 and 89.1%, respectively. The rate of DFS and OS was significantly higher in stages I and II compared with that in stage III (P < 0.05), and in stages IIIA and IIIB compared with that in stage IIIC (P < 0.05).

Conclusions: Laparoscopic CME with a caudal-to-cranial medial approach in the treatment of right colon cancer had good short-term efficacy and satisfactory oncological outcome.

Keywords: Complete mesocolic excision; Laparoscopy; Right colon cancer.

Conflict of interest statement

Ethics approval and consent to participate

The research protocols were approved by the ethical committee of the hospital (2010-SRFA-108). A written informed consent was obtained from all subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Position of operative ports
Fig. 2
Fig. 2
Superior mesenteric vein surgical trunk and its tributaries (1: surgical trunk; 2: right tributary of arteria colica media; 3: middle colic vein; 4: gastrocolic trunk of Henle; 5: venae gastroepiploica dextra; 6: right colic vein; 7: superior pancreaticoduodenal vein; 8: head of pancreas; 9: duodenum)
Fig. 3
Fig. 3
OS curves of different TNM stages
Fig. 4
Fig. 4
DFS curves of different TNM stages

References

    1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–616. doi: 10.1002/bjs.1800691019.
    1. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Color Dis. 2009;11:354–364. doi: 10.1111/j.1463-1318.2008.01735.x.
    1. Zhang C, Xue Q, Li GX, Ding ZH, Zhong SZ. Live anatomical observation of vessels related to laparoscopic right hemicolectomy. Chinese Journal Of Clinical Anatomy. 2012;30:256–9.
    1. Kang J, Kim IK, Kang SI, Sohn SK, Lee KY. Laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc. 2014;28:2747–2751. doi: 10.1007/s00464-014-3521-y.
    1. Adamina M, Manwaring ML, Park KJ, Delaney CP. Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc. 2012;26:2976–2980. doi: 10.1007/s00464-012-2294-4.
    1. Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, et al. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc. 2012;26:3669–3675. doi: 10.1007/s00464-012-2435-9.
    1. Li BG, Nie XY, He YZ, Xie HH, Yu GZ, Du HP, et al. The standardized practice of laparoscopic-assisted radical right hemicolectomy in order to achieve complete mesocolic excision. Zhonghua Wai Ke Za Zhi. 2012;50:215–218.
    1. Zhao GL, Chen Y. Clinical efficacy of laparoscopic complete mesoreclalexcisionwith a medial-to-lateral approach for right colonic cancer. Chin J Dig Surg. 2014;13:645–647.
    1. Yin F, Weng ZB, Cen H. The effect of complete mesocolic excision in the operation of right colon cancer under laparoscope. Chin J Laparoscopic Surgery (Electronic Edition) 2015;8:19–22.
    1. Xu P, Ren L, Zhu D, Lin Q, Zhong Y, Tang W, et al. Open right hemicolectomy: lateral to medial or medial to lateral approach? PLoS One. 2015;10:e0145175. doi: 10.1371/journal.pone.0145175.
    1. Yan J, Ying MG, Zhou D, Chen X, Chen LC, Ye WF, et al. A prospective randomized control trial of the approach for laparoscopic right hemi-colectomy:medial-to-lateral versus lateral-to-medial. Zhonghua Wei Chang Wai Ke Za Zhi. 2010;13:403–405.
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30. doi: 10.3322/caac.21332.
    1. Xiao Y, Qiu HZ, Wu B, Sun XY. Outcome of laparoscopic radical right hemicolectomy with complete mesocolic resection and D3 lymphadenectomy. Chin J Surg. 2014;52:249–253.
    1. Nakamura T, Mitomi H, Onozato W, Sato T, Ikeda A, Naito M, et al. Short- and long-term outcomes of laparoscopic surgery in patients with pathological stage II and III colon cancer. Hepato-Gastroenterology. 2011;58:1947–1950.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe