Complete mesocolic excision for right sided colonic carcinoma - Our Experience in tertiary care hospital

Abstract

Background: The concept of Complete Mesocolic Excision(CME) as a surgical techniquefor colonic carcinoma.was first introduced in the west in 2008. CME follows the sameprinciple as Total MesorectalExcision(TME) in rectal carcinoma. We have adopted this newtechnique since 2014.
 Objective: Here we describe the CME technique in open and laparoscopic right hemicolectomy,and our initial experience of the surgery.
 Methods: This is a prospective observational study. Data collected from 24 patientsadmitted under our care in BIR DEM General Hospital from January 2015 to January 2017with carcinoma caecum or ascending colon.
 Results: Out of 24 patients 14 patients opted for laparoscopic right hemicolectomy and 10patients choose open right hemicolectomy. In laparoscopic right hemicolectomy with CMEthe mean operating time was 152 minutes, amount of blood loss ranges 70-100ml.Number of lymphnodes removed enbloc with specimen 25-30(mean27). Distance oftumor from mesenteric margins at the point of vascular tie 11-15 cm. In open righthemicolectomy with CME mean operating time was 142 minutes, estimated blood loss120-300 ml, harvested lymph nodes within mesocolic envelop 24-31(mean27), anddistance of tumor from vascular tie is 9-15 cm. there is one major complication of uretericinjury. Histopathology shows resection margin are free of tumor in all except 2 cases.
 Conclusion: Right hemicolectomy with CME in both open and laparoscopic approach canbe easily adopted by general surgeons and colorectal surgeons who are performing'standard technique' or 'conventional technique' routinely for right hemicolectomy. Withthe encouraging results available from centers who are routinely performing CME incolonic surgery it is now considered as the new bench mark of quality of standard colonicsurgery.
 Journal of Surgical Sciences (2017) Vol. 21 (1) :15-18

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

“…Among the examined studies, patients with stage IV disease were excluded, except for one [ 18 ]. The other studies include stages I, II and III, but two [ 14 , 25 ] only included stage III cancers and two [ 22 , 26 ] only included stages II and III; in addition, five studies [ 15 , 28 – 30 , 32 ] do not indicate the TNM stage.…”

“…Four studies [ 23 , 25 , 32 , 33 ] reported on surgical intraoperative complications (vascular injuries, iatrogenic small bowel perforation) (607 patients). These were lower in the open (0.36%, 1/275) than in the laparoscopic group (1.2%, 4/332), but the result was not statistically significant (RR 1.72, 95% CI 0.38 to 7.85; I 2 = 0%) (SDC 12).…”

“…There were one RCT, performed at Menoufia University (Egypt) [15,16] and 20 CCTs [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Sixteen studies were performed in Asia (4601 patients, 91.3%), including 13 from China (2158 patients), 2 from South Korea (2419 patients) and 1 from Bangladesh (24 patients).…”

“…Among the examined studies, patients with stage IV disease were excluded, except for one [18]. The other studies include stages I, II and III, but two [14,25] only included stage III cancers and two [22,26] Concerning tumour localisation, all of the studies considered cancers of cecum, ascending colon and hepatic flexure, while only five studies [17,20,22,31,32] also included proximal transverse colonic neoplasms.…”

“…The overall number of harvested lymph nodes was reported in 3876 patients (19 studies) [14,15,[17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][35]. The number of nodes was higher in the laparoscopic group, but the difference was not statistically significant (MD 0.68, − 0.41-1.76, P = 0.22, I 2 = 90%).…”