Comparison of outcomes of complete mesocolic excision with conventional radical resection performed by laparoscopic approach for right colon cancer

Abstract

Manzhao Ouyang,1,2,* Zhentao Luo,1,* Jinhao Wu,1,* Weijie Zhang,1 Shibin Tang,1 Yan Lu,1 Weixian Hu,2,3 Xueqing Yao2,3 1Department of Gastrointestinal Surgery, Shunde Hospital, Southern Medical University, Foshan, Guangdong Province 528308, People’s Republic of China; 2Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000, People’s Republic of China; 3Department of General Surgery, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510080, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xueqing YaoDepartment of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshaner Road, Guangzhou, Guangdong 510000, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: This retrospective study compared the outcomes of laparoscopic complete mesocolic excision (CME) guided by superior mesenteric artery with laparoscopic conventional radical resection (CRR) performed for right-sided colon cancer.Methods: Patients with right-sided colon cancer underwent CME (n=107; January 2011 to December 2015) or CRR (n=60; January 2008 to December 2010).Results: The 2 groups were comparable regarding age, gender, body mass index, maximum tumor diameter, and tumor stage. In the CME group, the distances between the tumor and the high vascular tie (HVT; 12.6 cm), and between the closest bowel wall and HVT (10.4±0.9 cm) was significantly greater than that of the CRR group (11.5 cm and 9.3±1.0 cm, respectively; P<0.001). In the CME group, the number of retrieved lymph nodes (23.2) was significantly higher, and the volume of intraoperative bleeding (108.4 mL) was less than that of the CRR (14.0 and 128.7 mL; P<0.001). The length of resected bowel in the 2 groups was similar (25.8±0.7 cm and 25.5±2.1 cm; P=0.106), as was the operative time, postoperative hospitalization, time of first bowel movement, and complications. The 3-year recurrence rate of the CME group (8.4%) was significantly lower than that of the CRR (20.0%), the 3-year overall survival was significantly higher (93.5% cf. 85.0%), and the survival rates of T4 stage, N1 stage, pTNM stage II, pTNM stage III and lympho vascular invasion were significantly higher (P<0.05). The 2 groups were similar for survival rates of Tis, T1, T2, T3, N2 stage, pTNM stage I and perineural invasion (P>0.05).Conclusion: CME for right-sided colon cancer guided by superior mesenteric artery has similar short-term outcomes, higher lymph node yield, and higher 3-year overall survival compared with CRR.Keywords: laparoscopy, right-sided colon cancer, complete mesocolic excision

Keywords

• Laparoscopy
• right-sided colon cancer
• complete mesocolic excision