Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision?

Bertelsen, Claus Anders; Bols, Birgitte; Ingeholm, Peter; Jansen, Jens Erik; Neuenschwander, Anders Ulrich; Vilandt, Jesper

doi:10.1111/j.1463-1318.2010.02474.x

Cited by 144 publications

(124 citation statements)

References 24 publications

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“…A Danish group has recently published their initial results regarding pathology and surgical morbidity [25]. Laparoscopic resections were restricted to locations other than the transverse colon.…”

Section: Discussionmentioning

confidence: 99%

Outcome after Introduction of Complete Mesocolic Excision for Colon Cancer Is Similar for Open and Laparoscopic Surgical Treatments

Storli

Søndenaa²,

Furnes³

et al. 2013

Dig Surg

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Background: Complete mesocolic excision (CME) and a high (apical) vascular tie may improve oncologic outcome after surgery for colon cancer. Our primary aim was to emulate a previous national result of 73.8% overall survival (OS) with both the open and laparoscopic techniques. Methods: A prospective study of radical colon cancer was initiated in a Norwegian community teaching hospital in 2007 and comprised a consecutive group of 251 patients with TNM stages I-III that had surgery according to the CME principle. Oncological outcome was assessed as OS, disease-free survival (DFS) and cancer-specific survival (CSS), as well as time to recurrence (TTR), using Cox regression analysis. Results: In-hospital mortality was 3.6%, 2.3% for laparoscopic surgery and 4.9% for open management. Significantly more patients in the open CME group developed complications in the short term (p < 0.001). Twelve or more lymph nodes were retrieved from 82.9% (208/251) of the specimens. Overall 3-year OS was 84.5%, DFS 77.4%, CSS 91.5% and TTR 86.8%. The surgical approach was not a significant predictor for any of the survival parameters. Conclusions: There was no survival difference between open and laparoscopic CME colonic resections, and the present OS improved from a previous OS from 2000.

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Section: Discussionmentioning

confidence: 99%

Outcome after Introduction of Complete Mesocolic Excision for Colon Cancer Is Similar for Open and Laparoscopic Surgical Treatments

Storli

Søndenaa²,

Furnes³

et al. 2013

Dig Surg

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show abstract

“…Höhere Komplikationsraten scheinen mit Erhöhung der Radikalität nicht verbunden zu sein [710]. Die bisherigen Daten deuten auf eine Verbesserung der Überlebensraten bei konsequenter Durchführung der CME hin [708].…”

Section: Vorgehen Bei Karzinomen Des Mittleren Colon Transversumunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

136

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“…The proponents of CME state that the radical lymph node dissection in colon cancer is not associated with inferior outcomes for the patient [46]. No adverse effects were observed when the dissection is performed in embryonic planes preserving the autonomous nerves [45,46,47]. The complication rates were not increased compared to other studies, even to those with limited lymphatic dissection.…”

Section: Resultsmentioning

confidence: 57%

“…While the proponents of ‘high tie' surgery point to improved survival and better oncological outcomes, this has yet to be replicated in systematic reviews and large data cohorts [50,51]. In one study introducing CME surgery as a routine, the mean gain in lymph node was 2 (from 25 to 27) [47], which is unlikely to represent an oncological difference. Again, this points to other factors than surgery that may influence the lymph node yield.…”

Section: Resultsmentioning

confidence: 99%

Qualitative and Quantitative Issues of Lymph Nodes as Prognostic Factor in Colon Cancer

Veen¹,

Nedrebø²,

Stormark³

et al. 2013

Dig Surg

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For patients undergoing curative resections for colon cancer, the nodal status represents the strongest prognostic factor, yet at the same time the most disputed issue as well. Consequently, the qualitative and quantitative aspects of lymph node evaluation are thus being scrutinized beyond the blunt distinction between ‘node positive' (pN+) and ‘node negative' (pN0) disease. Controversy ranges from a minimal or ‘least-unit' strategy as exemplified by the ‘sentinel node' to a maximally invasive or ‘all inclusive' approach by extensive surgery. Ranging between these two extremes of node sampling strategies are factors of quantitative and qualitative value, which may be subject to modification. Qualitative issues may include aspects of lymph node harvest reflected by surgeon, pathologist and even hospital performance, which all may be subject to modification. However, patient's age, gender and genotype may be non-modifiable, yet influence node sample. Quantitative issues may reflect the balance between absolute numbers and models investigating the relationships of positive to negative nodes (lymph node ratio; log odds of positive lymph nodes). This review provides an updated overview of the current controversies and a state-of-the-art perspective on the qualitative and quantitative aspects of using lymph nodes as a prognostic marker in colon cancer.

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Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision?

Abstract: Standardization of colonic cancer surgery with CME seems to improve the quality of surgery without increasing the risk of complications.

Cited by 144 publications

References 24 publications

Outcome after Introduction of Complete Mesocolic Excision for Colon Cancer Is Similar for Open and Laparoscopic Surgical Treatments

Outcome after Introduction of Complete Mesocolic Excision for Colon Cancer Is Similar for Open and Laparoscopic Surgical Treatments

S3-Leitlinie – Kolorektales Karzinom

Qualitative and Quantitative Issues of Lymph Nodes as Prognostic Factor in Colon Cancer

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