Improving the Quality of Colon Cancer Surgery Through a Surgical Education Program

West, Nicholas P.; Sutton, Kate; Ingeholm, Peter; Hagemann‐Madsen, Rikke; Hohenberger, Werner; Quirke, Philip

doi:10.1007/dcr.0b013e3181f433e3

Cited by 99 publications

(102 citation statements)

References 27 publications

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“…CME was implemented at one of the four colorectal centres in the Capital Region of Denmark in 2008 2 . The other centres have been reluctant to implement extended surgery owing to safety concerns 3 , although externally validated pathological parameters (lymph node yield, distance from tumour to vascular high tie, and intact mesocolic fascia) were higher in the centre performing CME 4 . CME in this study is defined 5,6 as dissection in the mesocolic plane with central vessel ligation.…”

Section: Introductionmentioning

confidence: 99%

Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery

Bertelsen

Neuenschwander

Jansen

et al. 2016

British Journal of Surgery

170

134

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Section: Introductionmentioning

confidence: 99%

Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery

Bertelsen

Neuenschwander

Jansen

et al. 2016

British Journal of Surgery

170

134

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“…CME includes more mesentery than the more common standard D2 resection [1,2]. In order to document such a radical approach, the length and area of the excised mesentery may be measured or the number of lymph nodes retrieved may act as a surrogate measure of radical surgery [3]. The survival benefit of a large lymph node harvest has been shown in several reports [1,4,5].…”

Section: Introductionmentioning

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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“…In this scenario, major influential factors are the primary tumor site (colon vs. rectum) and treatment variables. In the past, survival was from 5 % to 10 % higher for colon than for rectal cancer [40,41]. Over the decades the widespread usage in rectal surgery of total mesorectal excision (TME) procedures popularized by Heald and Ryall [42], together with neoadjuvant chemoradiotherapy protocols in advanced cases, have lowered local recurrence rates and improved survival [43][44][45].…”

Section: Proactive Management Of Peritoneal Metastases From Colorectamentioning

confidence: 99%

Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

Sammartino

Biacchi

Cornali

et al. 2016

Indian J Surg Oncol

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An integrated treatment strategy using peritonectomy procedures plus hyperthermic intraperitoneal chemotherapy (HIPEC) is now a clinical standard of care in selected patients with peritoneal metastases and primary peritoneal tumors. This comprehensive approach can offer many patients, who hitherto had no hope of cure, a good quality of life and survival despite limited morbidity. The increasingly successful results and chance of interfering in the natural history of disease has prompted research to develop for some clinical conditions a therapeutic strategy designed to prevent malignant peritoneal dissemination before it becomes clinically evident and treat it microscopically (tertiary prevention). The main factor governing successful cytoreductive surgery and predicting outcome is the extent of peritoneal spread assessed with the peritoneal cancer index (PCI). In peritoneal metastases from colorectal and gastric cancer the PCI score acquires a specific role acting as the cut-off between patients who can undergo curative surgery or palliation. Long-term results show that the only group enjoying favorable results are patients with limited disease (a statistical minority). By applying to appropriately selected patients with primary malignancies a proactive management strategy including HIPEC we can treat patients with microscopic peritoneal dissemination and therefore at PCI 0. Among treated conditions pseudomyxoma peritonei enjoys the best results. But a major future advance comes from identifying among lesions at major risk of pseudomyxoma.

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Improving the Quality of Colon Cancer Surgery Through a Surgical Education Program

Cited by 99 publications

References 27 publications

Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery

Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery

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

Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

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