Wide excision in right-sided colon cancer is associated with decreased survival

Abstract

Background and Aims: Nodal involvement is the most important prognostic factor in colon cancer. Although theoretically appealing, it is not known if wider mesenteric excision improves the oncological result. The aim of this retrospective study was to investigate whether wider mesenteric excision yields a superior oncological result. Material and Methods: Depending on the resection length, 333 cases of locally radical right-sided hemicolectomies due to adenocarcinoma were compared for perioperative morbidity and mortality, disease-free survival, and long-term survival. Results: Postoperative mortality was significantly higher in the quartile with the longest resections, p = 0.003. In a multivariate analysis adjusted for age, stage, emergency operation, adjuvant chemotherapy, and year of operation, a negative relationship between resection length and 5-year overall survival was noted, p = 0.01. No differences in the causes of death or in the incidence of local or distant recurrences were noted between groups. Conclusions: Wider excision in right-sided hemicolectomies was not associated with any oncological benefit but an increased postoperative mortality and a decreased 5-year overall survival. These findings may suggest consideration to perform wide mesenteric resections routinely. Further research is warranted to define which patients benefit from wider resections.

Improved survival for rectal cancer compared to colon cancer: the four cohort study

“…The worse overall survival of colon cancer is most likely multi‐factoral. Recently complete mesocolic excision (CME) and high ligation of the artery have been emphasized although data are opposing . Furthermore, a larger proportion of colonic resections are still performed by General Surgeons where as rectal cancer is almost exclusively managed by Colorectal specialists.…”

“…Recently complete mesocolic excision (CME) and high ligation of the artery have been emphasized although data are opposing. 8,9 Furthermore, a larger proportion of colonic resections are still performed by General Surgeons where as rectal cancer is almost exclusively managed by Colorectal specialists. In the last cohort there was a tendency to improved survival for stage I and II disease in colon cancer if operated by a colorectal surgeon which underlines the importance of sub-specialization.…”

No benefit of extended mesenteric resection with central vascular ligation in right‐sided colon cancer

“…There is no rationale in performing an extended resection if a more limited resection is adequate regarding survival and oncological results. In a previous retrospective study our group has shown an increased long‐term mortality associated with wider bowel resection in right‐sided colon cancer .…”

Improvement of Survival over Time for Colorectal Cancer Patients: A Population-Based Study

“…Adjuvant chemotherapy in stages II and III of colon cancer has shown to increase survival by 5-15% in randomized trials [21]. Nevertheless, complete mesocolic excision and central vascular ligation have been emphasized recently, although data are opposing [22][23][24].…”