Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study

Bertelsen, Claus Anders; Neuenschwander, Anders Ulrich; Jansen, Jens Erik; Wilhelmsen, Michael; Kirkegaard-Klitbo, Anders; Tenma, Jutaka; Bols, Birgitte; Ingeholm, Peter; Rasmussen, L. A.; Jepsen, Lars Vedel; Iversen, Else R; Kristensen, Bent Bruun; Gögenur, Ismail

doi:10.1016/s1470-2045(14)71168-4

Cited by 401 publications

(352 citation statements)

References 26 publications

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“…Arterial blood supply, venous and lymphatic drainage take place within the boundaries of the mesocolon; and it is presumed that there are no compartment-crossing vessels that could potentially pave the way to cancer spread outwith the main route along the colic arteries [6]. It has been proven that CME results in a higher lymph node yield, a larger area of mesentery removed, a greater distance between the tumor and the central vascular tie and ultimately in better patient outcome [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Anatomy of the transverse colon revisited with respect to complete mesocolic excision and possible pathways of aberrant lymphatic tumor spread

Stelzner

Hohenberger

Weber

et al. 2015

Int J Colorectal Dis

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Section: Introductionmentioning

confidence: 99%

Anatomy of the transverse colon revisited with respect to complete mesocolic excision and possible pathways of aberrant lymphatic tumor spread

Stelzner

Hohenberger

Weber

et al. 2015

Int J Colorectal Dis

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“…Even though this simplified surgical rat model does not completely reflect the human situation, as multiple peri- and post-operative factors (e.g. complete mesocolic excision) 53 may influence patient outcome, collectively our data support that bacterial spillage during CRC resection may contribute to liver metastases outgrowth. Fecal sample analysis demonstrated that all rats had a highly individualized microbiota composition with a highly diverse array of Bacteroidetes, Firmicutes and Proteobacteria.…”

Section: Discussionmentioning

confidence: 63%

Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model.

et al. 2018

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Surgical resection of the primary tumor provides the best chance of cure for patients with colorectal carcinoma (CRC). However, bacterial translocation during intestinal surgery has been correlated with poor long-term oncological outcome. Therefore, we investigated the influence of bacterial contamination during colon surgery on CRC liver metastases development. Blood and liver samples of patients undergoing resection of primary CRC or liver metastases were collected. Cell numbers, activation markers and inflammatory mediators were determined. Tumor cell adhesion and outgrowth after sham- or colectomy operations were determined in a rat model, in which tumor cells had been injected into the portal vein.White blood cells and granulocytes were increased in per- and post-operative patient blood samples. IL-6 was also increased post-operatively compared to the preoperative level. Expression of NOX-2, NOX-4 and polymorphonuclear cells (PMNs) numbers were elevated in post-operative human liver samples. In vitro stimulation of macrophages with plasma of rats after colectomy resulted in production of reactive oxygen species (ROS). Colectomy in rats increased D-lactate levels in plasma, supporting bacterial translocation. Decreased expression of tight junction molecules and increased tumor cell adhesion and outgrowth was observed. Treatment with a selective decontamination of the digestive tract (SDD) cocktail decreased tumor cell adherence after colectomy.In conclusion, postoperative bacterial translocation may activate liver macrophages and PMNs, resulting in ROS production. As we previously showed that ROS release led to liver vasculature damage, circulating tumor cells may adhere to exposed extracellular matrix and grow out into liver metastases. This knowledge is pivotal for development of therapeutic strategies to prevent surgery-induced liver metastases development.

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“…The procedure, known under the generic name of total mesocolic excision, consists of an extended dissection of the affected colic segment carried out in the embryologically defined mesocolic planes in order to remove all the lymphatic trunks situated along the vessels which provide the blood supply of the region [4]. In this way the resected specimen is characterized by a greater distance between the tumor and the site of ligation of the main blood vessels [8]. However, initially the method remained controversial [8].…”

Section: Introductionmentioning

confidence: 99%

“…In this way the resected specimen is characterized by a greater distance between the tumor and the site of ligation of the main blood vessels [8]. However, initially the method remained controversial [8]. For example, in Denmark the concept of complete mesocolic excision for colon cancer was implemented in 2008 in a single center (Hillerod) while the other three centers in the Capital Region of Denmark refused the implementation of the technique.…”

Section: Introductionmentioning

confidence: 99%

“…For example, in Denmark the concept of complete mesocolic excision for colon cancer was implemented in 2008 in a single center (Hillerod) while the other three centers in the Capital Region of Denmark refused the implementation of the technique. One year later, the quality of the specimens in the four centers was examined by the pathologists and significant differences in terms of resected lymph nodes and of distance between the tumor and the vascular tie being reported between the two groups [8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Optimal Colonic Cancer Surgery- the Concept of Complete Mesocolic Excision

BacalbaÈa¹,

Lintoiu²,

Bălescu³

2016

J Neoplasm

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Although colorectal cancer is one of the most common malignancies worldwide, the colon cancer related mortality significantly decreased in the last decades due to the wide implementation of screening programs and due to a better therapeutic approach. Once Heald introduced the concept of total mesorectal excision and demonstrated its' benefits in terms of oncological outcomes, attention was focused on the possibility of implementation of a similar technique for patients with colon cancer. This is how the concept of complete mesocolic excision appeared. This is a literature review regarding the surgical technique and oncologic outcomes of complete mesocolic excision.

show abstract

Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study

Cited by 401 publications

References 26 publications

Anatomy of the transverse colon revisited with respect to complete mesocolic excision and possible pathways of aberrant lymphatic tumor spread

Anatomy of the transverse colon revisited with respect to complete mesocolic excision and possible pathways of aberrant lymphatic tumor spread

Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model.

Optimal Colonic Cancer Surgery- the Concept of Complete Mesocolic Excision

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