Postoperative morbidity of complete mesocolic excision and central vascular ligation in right colectomy: a retrospective comparative cohort study

Prevost, Gian Andrea; Odermatt, Manfred; Furrer, Markus; Villiger, Peter M.

doi:10.1186/s12957-018-1514-3

Cited by 39 publications

(38 citation statements)

References 21 publications

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“…A total of 19 publications met the inclusion criteria, and these were included in the final analysis ( Table 1). [2][3][4][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] There was a total of 25 688 patients who underwent surgery for colorectal cancer, who were dichotomised into two groups; patients who underwent CME, and those who underwent traditional colectomy. A total of 14 431 patients (56.2%) underwent CME.…”

Section: Resultsmentioning

confidence: 99%

“…23,24 Prevost et al reported that most vascular injuries occurred around the SMV. 14 As with all procedures, there is a learning curve that can mitigate the risk of such operative complications, with the learning curve estimated to be between 23 and 25 cases in published literature. 25,26 While the rate of vascular injury was significantly higher with CME in our study, other technical markers were reassuring, with no differences noted between the CME and non-CME groups with regards to intra-operative blood loss, operative time, post-operative anastomotic leak or LOS in hospital.…”

Section: Discussionmentioning

confidence: 99%

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Oncological reasons for performing a complete mesocolic excision: a systematic review and meta‐analysis

Kong

Prabhakaran

Choy

et al. 2021

ANZ Journal of Surgery

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Background While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be weighed up against the risk of major intra‐abdominal complications. This paper aimed to assess the comparative oncological benefits of CME. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines, a systematic review of the literature until May 2020 was performed. Comparative studies assessing CME versus conventional colonic surgery for colon cancer were compared, and outcomes were pooled. Results A total of 700 publications were identified, of which 19 were found to meet the inclusion criteria. A total of 25 886 patients were compared, with 14 431 patients in the CME arm. CME was associated with a significantly higher rate of vascular injury (odds ratio 3, P < 0.001). Rates of local and distant recurrence were lower in the CME group (odds ratio 0.66 and 0.73, respectively, both P < 0.001). CME patients had a significantly higher lymph node yield (P < 0.001). While no significant differences were noted between the two groups in terms of pooled 3‐ or 5‐year disease‐free survival, pooled 5‐year overall survival was significantly higher in the CME group (relative risk 0.82, P < 0.001). Conclusion Based on the available evidence, CME is associated with improved oncologic outcomes at the expense of higher complication rates, including vascular injury. The oncological benefits need to weighed up against a multitude of factors including the level of hospital support, surgeon experience, patient age, and associated comorbidities.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Oncological reasons for performing a complete mesocolic excision: a systematic review and meta‐analysis

Kong

Prabhakaran

Choy

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

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“…Although CME and CVL should be considered the standard of oncological surgery, some concerns emerged in the literature due to the potential increasing of perioperative mortality and morbidity; Prevost et al 15 demonstrated an higher mortality in patients treated with CME/CVL mainly due to aspiration pneumonia; recent data did not demonstrate a significant advantage of CME/CVL in regard to long-term disease-free survival, but the literature failed to demonstrate the advantages of CME/CVL in term of severe morbidity, chronic pain, and delayed gastric emptying or peristalsis. 16 A careful patient selection, with particular attention to general health conditions, to associated comorbidities and to tumor stage seems to be crucial in order to avoid to nullify the potential advantages of a more efficient oncological procedure with an unacceptable perioperative morbidity rate.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Laparoscopic Right Colectomy with Complete Mesocolic Excision

Olmi¹,

Oldani²,

Cesana³

et al. 2020

JSLS

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Background and Objectives: Literature demonstrates that colorectal cancer is nowadays one of the most common malignancies. Laparoscopy and robotic surgery are progressively gaining popularity in the treatment of colorectal tumors. Complete mesocolic excision and central vascular ligation have been widely adopted with encouraging results in terms of an improvement of overall survival, but some studies in the literature seem to demonstrate a higher morbidity rate. Methods: We conducted a retrospective study from 01/ 01/2010 to 30/04/2019 on a series of 250 patients, 155 males (62%) and 95 females (38%) who underwent right colectomy with minimally invasive approach, complete mesocolic excision, central vascular ligation, and intracorporeal anastomosis. Results: No perioperative mortality occurred. Postoperative morbidity rate was 6%, including 10 cases of anastomotic leak (5%). Conversion rate was 2.5%. Mean hospital stay was 6 days (range, 4-25 days). Mean operative time was 70 minutes (range, 50-130 minutes). No cases of duodenal or pancreatic damages, no chronic pain or diarrhea, and no severe alteration of bowel function were recorded. We observed only 3 cases of transient delayed gastric emptying. Conclusions: Laparoscopic right colectomy with complete mesocolic excision, central vascular ligation and intracorporeal anastomosis leads to encouraging oncological mid-and long-term outcomes with low complications rates.

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“…Increased morbidity has been reported early in the learning curve of surgeons converting to CME. 36,37 It becomes evident that implementation of CME and, in particular, SILS CME should be under supervision.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Single-Incision Versus Multiport Laparoscopic Complete Mesocolic Excision Colectomy for Colon Cancer

et al. 2019

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Background. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. Methods. MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. Results. Seven studies (3 randomized) with a total number of 1344 patients were included (546 SILS CME and 798 MPL CME). No difference was found in anastomotic leakage (odds ratio [OR] = 0.79 [0.31 to 2.03]; P = .63), number of lymph nodes (weighted mean difference [WMD] = 0.85 [−0.97 to 2.66]; P = .36), hospital stay (WMD = 0.01 [−0.19 to 0.20]; P = .96), overall survival (hazard ratio [HR] = 1.19 [0.29 to 4.80]; P = .81), and disease-free survival (HR = 1.30 [0.30 to 5.61]; P = .72). Skin incision was shorter in SILS CME group (WMD = −3.02 [−3.25 to −2.80]; P < .00001) but with no difference in pain reported in postoperative day 1 (standardized mean difference [SMD] = −0.21 [−0.50 to 0.09]; P = .17) or day 2 (SMD = 0.16 [−0.52 to 0.84]; P = .64). Conclusions. SILS CME, although technically more demanding, has equivalent short- and long-term outcomes when compared with MPL CME. Potential benefits in cosmesis or postoperative pain need to be further explored by high-quality randomized controlled trials.

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Postoperative morbidity of complete mesocolic excision and central vascular ligation in right colectomy: a retrospective comparative cohort study

Cited by 39 publications

References 21 publications

Oncological reasons for performing a complete mesocolic excision: a systematic review and meta‐analysis

Oncological reasons for performing a complete mesocolic excision: a systematic review and meta‐analysis

Surgical Outcomes of Laparoscopic Right Colectomy with Complete Mesocolic Excision

A Systematic Review and Meta-Analysis of Single-Incision Versus Multiport Laparoscopic Complete Mesocolic Excision Colectomy for Colon Cancer

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