Complete Mesocolic Excision and D3 Lymphadenectomy versus Conventional Colectomy for Colon Cancer: A Systematic Review and Meta-Analysis

Vico, Tamara Díaz; Fernández-Hevia, María; Suárez-Sánchez, Aida; García-Gutiérrez, Carmen; Mihic-Góngora, Luka; Fernández-Martínez, Daniel; Álvarez-Pérez, José Antonio; Otero-Díez, Jorge Luis; Granero-Trancón, José E; Flórez, Luis

doi:10.1245/s10434-021-10186-9

Cited by 30 publications

(14 citation statements)

References 51 publications

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“…So that, the CME concept was based on three main points: dissection in the embryological plane, central vascular ligation, and a su cient length of resected bowel. Recently, in two systematic review, Complete mesocolic excision has showed favorite results on long-term survival outcomes, but no differences in anastomotic leak rate or perioperative mortality [11,23]. However, these reviews still have some limitations on the quality of evidence, which have no Level 1 evidence from a randomized clinical trial (RCT) [11].…”

Section: Discussionmentioning

confidence: 99%

Bach Mai Procedure with Combining Approach and Early Resection of The Terminal Ileum for Total Laparoscopic Right Hemicolectomy: A prospective study

Nguyen

et al. 2023

Preprint

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Purpose. Total laparoscopic right hemicolectomy with complete mesocolic excision (CME), central vascular ligation (CVL) and D3 lymphadenectomy is still the most challenging colon procedures for gastrointestinal surgeons. We herein report the technical details and our preliminary experience of Bach Mai Procedure - a novel combining approach and early resection of the terminal ileum. Methods. The Dissection Stage was central vascular isolation and ligation by a combined multiple approaches in the following four steps: (Cranial approach) dissecting along the inferior aspect of pancreatic isthmus to reveal the middle colic vessels and the anterior aspect of the superior mesentery vein, then exposed the right gastroepiploic vein and the trunk of Henle; (Medial-to-lateral approach) exposing the surgical axis - the superior mesenteric vascular axis, then early resection of the terminal ileum to open the dissection from the bottom up; (Caudal approach) radical ligation of the ileocecal artery and right colic artery (central vascular ligation), lymph node dissection (D3 lymphadenectomy) and (Lateral-to-medial approach) resecting the Toldt fascia of the colon to release the entire right colon from the abdominal wall. Results. In 12 months, there were 32 cases of primary right-sided colon malignancies that have undergone tLRHD3, CME/CVL based on the novel combining approach and early resection of the terminal ileum. In 3 cases (9.4%), the tumor site was hepatic flexure. The median of lymph node number (LNN) was 38, with the maximum number was 101. No serious postoperative complications (grade III or higher) neither in-hospital mortality was detected. Conclusion. This novel combining approach and early resection of the terminal ileum is technically feasible and safe for tLRHD3, CME/CVL. Further investigations and follow-up must be proceeded to evaluate the long-term outcomes of our technique.

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Section: Discussionmentioning

confidence: 99%

Bach Mai Procedure with Combining Approach and Early Resection of The Terminal Ileum for Total Laparoscopic Right Hemicolectomy: A prospective study

Nguyen

et al. 2023

Preprint

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“…Despite the limited randomized data available for CME surgery for colon cancer, the interest in the procedure is reflected by the fact that there were 13 systematic reviews published on the topic between 2009 and 2020, and at least an additional 9 systematic reviews published in 2021 alone. [35][36][37][38][39][40][41][42][43] Pathological outcomes CME with CVL has been shown to be associated with a greater distance between the tumour and vascular tie, a longer colonic specimen length, a larger mesenteric resectional area and higher lymph node yield. 13,36,43 Although higher lymph node yields have been associated with a survival benefit in patients with clinically positive and negative lymph nodes, [44][45][46][47][48] recent genomic and proteomic data have demonstrated a strong correlation between lymph node yield and immune response, where the survival advantage associated with higher lymph node yields is most likely explained by the induction of an immune response.…”

Section: Discussionmentioning

confidence: 99%

Complete mesocolic excision for colon cancer: current status and controversies

Brown,

Ng,

Solomon

et al. 2023

ANZ Journal of Surgery

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According to Hohenberger's original description, complete mesocolic excision for colon cancer involves precise dissection of the avascular embryonic plane between the parietal retroperitoneum and visceral peritoneum of the mesocolon. This ensures mesocolic integrity, access to high ligation of the supplying vessels at their origin and an associated extended lymphadenectomy. Results from centres which have adopted this approach routinely have demonstrated that oncological outcomes can be improved by the rigorous implementation of established principles of cancer surgery. Meticulous anatomical dissection along embryonic planes is a well‐established principle of precision cancer surgery used routinely by the specialist colorectal surgeon. Therefore, the real question concerns the need for true central vascular ligation and associated extended (D3) lymphadenectomy or otherwise, particularly along the superior mesenteric vessels when performing a right colectomy. Whether this approach results in improved overall or disease‐free survival remains unclear and its role remains controversial particularly given the potential for significant morbidity associated with a more extensive central vascular dissection. Current literature is limited by considerable bias, as well as inconsistent and variable terminology, and the results of established randomized trials are awaited. As a result of the current state of equipoise, various national guidelines have disparate recommendations as to when complete mesocolic excision should be performed if at all. This article aims to review the rationale for and technical aspects of complete mesocolic excision, summarize available short and long term outcome data and address current controversies.

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“…This superior lymphadenectomy may account for the lower reported risk of local recurrence in some studies [ 6 , 7 , 8 , 9 ]. However, several articles have shown that wider excisions did not improve oncologic benefits and CME has been associated with increasing concerns regarding the elevated morbidity and risk of postoperative complications such as injuries to the splenic and superior mesenteric veins [ 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous, Multi-Channel, Near-Infrared Fluorescence Visualization of Mesenteric Lymph Nodes Using Indocyanine Green and Methylene Blue: A Demonstration in a Porcine Model

et al. 2023

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Near-infrared fluorescence (NIRF) image-guided surgery is a useful tool that can help reduce perioperative complications and improve tissue recognition. Indocyanine green (ICG) dye is the most frequently used in clinical studies. ICG NIRF imaging has been used for lymph node identification. However, there are still many challenges in lymph node identification by ICG. There is increasing evidence that methylene blue (MB), another clinically applicable fluorescent dye, can also be useful in the intraoperative fluorescence-guided identification of structures and tissues. We hypothesized that MB NIRF imaging could be used for lymph node identification. The aim of this study was to evaluate the feasibility of intraoperative lymph node fluorescence detection using intravenously (IV) administered MB and compare it to ICG via a camera that has two dedicated near-infrared (NIR) channels. Three pigs were used in this study. ICG (0.2 mg/kg) was administered via a peripheral venous catheter followed by immediate administration of MB (0.25 mg/kg). NIRF images were acquired as video recordings at different time points (every 10 min) over an hour using the QUEST SPECTRUM® 3 system (Quest Medical Imaging, Middenmeer, The Netherlands), which has two dedicated NIR channels for simultaneous intraoperative fluorescence guidance. The 800 nm channel was used to capture ICG fluorescence and the 700 nm channel was used for MB. The target (lymph nodes and small bowel) and the background (vessels-free field of the mesentery) were highlighted as the regions of interest (ROIs), and corresponding fluorescence intensities (FI) from these ROIs were measured. The target-to-background ratio (TBR) was then computed as the mean FI of the target minus the mean FI of the background divided by the mean FI of the background. In all included animals, a clear identification of lymph nodes was achieved at all time points. The mean TBR of ICG in lymph nodes and small bowel was 4.57 ± 1.00 and 4.37 ± 1.70, respectively for the overall experimental time. Regarding MB, the mean TBR in lymph nodes and small bowel was 4.60 ± 0.92 and 3.27 ± 0.62, respectively. The Mann-Whitney U test of the lymph node TBR/small bowel TBR showed that the TBR ratio of MB was statistically significantly higher than ICG. The fluorescence optical imaging technology used allows for double-wavelength assessment. This feasibility study proves that lymph nodes can be discriminated using two different fluorophores (MB and ICG) with different wavelengths. The results suggest that MB has a promising potential to be used to detect lymphatic tissue during image-guided surgery. Further preclinical trials are needed before clinical translation.

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Complete Mesocolic Excision and D3 Lymphadenectomy versus Conventional Colectomy for Colon Cancer: A Systematic Review and Meta-Analysis

Cited by 30 publications

References 51 publications

Bach Mai Procedure with Combining Approach and Early Resection of The Terminal Ileum for Total Laparoscopic Right Hemicolectomy: A prospective study

Bach Mai Procedure with Combining Approach and Early Resection of The Terminal Ileum for Total Laparoscopic Right Hemicolectomy: A prospective study

Complete mesocolic excision for colon cancer: current status and controversies

Simultaneous, Multi-Channel, Near-Infrared Fluorescence Visualization of Mesenteric Lymph Nodes Using Indocyanine Green and Methylene Blue: A Demonstration in a Porcine Model

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