Complete mesocolic excision versus conventional surgery for colon cancer: A systematic review and meta‐analysis

Crane, Jasmine; Hamed, Mazin; Borucki, Joseph P; Elhadi, Ahmed; Shaikh, Irshad; Stearns, Adam T.

doi:10.1111/codi.15644

Cited by 39 publications

(30 citation statements)

References 61 publications

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“…This has been demonstrated to result in improved survival [41]. The benefits of complete mesocolic excision with central vascular ligation as described by Hohenberger [42] has been demonstrated in a recent systematic review that showed an improved 3‐ and 5‐year survival compared to ‘standard right colectomy’ for cancer [43]. Several randomized controlled trials have demonstrated that preoperative radiotherapy and chemoradiotherapy for non‐early rectal cancers and neoadjuvant chemotherapy for both advanced rectal (as part of total neoadjuvant therapy or alone) and colonic cancers result in less local recurrence and better overall and disease‐free survival compared to people who did not have preoperative treatment.…”

Section: Discussionmentioning

confidence: 99%

Rising incidence of colorectal cancer in individuals younger than 50 years and increasing mortality from rectosigmoid cancer in England

Lunevičius

Arthur

2021

Colorectal Disease

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Aim The aim was to describe changes in incidence and mortality from colorectal cancer (CRC) in England by analysing data available from the National Cancer Registration and Analysis Service (NCRAS, 2001–2017). Methods Data analysis was undertaken to interpret trends and patterns in age‐standardized incidence and death rates from CRC, including sub‐analyses by six age groups (0–24, 25–49, 50–59, 60–69, 70–79, 80+) and three sites of cancer—colonic, rectosigmoid and rectal. Results Overall CRC incidence remained relatively stable—70.1 cases per 100 000 individuals (95% CI 69.3–71.0) in 2001 and 68.8 cases (95% CI 68.0–69.5) in 2017. Sub‐analysis demonstrates a quarter fewer incidence of rectosigmoid cancer (−27%). This is counterbalanced by a 3% rise in colon cancers. The age‐standardized incidence rate of CRC increased by 59% in the 25–49 age group. In the over 50s, CRC incidence remained stable, with reductions seen in rectosigmoid cancer (50–59 years, −19%; 60–69, −26%; 70–79, −39%; 80+, −27%). Overall, mortality improved (−18.7%), primarily as a result of the reduction in deaths from colon (−31.6%) and rectal cancers (−25.1%). Deaths from the small incident number of rectosigmoid cancers, however, demonstrated a significant increase overall (+166.7%). Grouped age‐standardized death rate analyses showed increasing death rates in the under 50s (+28.3%) compared to declining rates in the over 50s (−15.8%). Conclusions There is a clear trend in increased incidence and mortality in individuals under 50 years old. There is also a trend to increased mortality from rectosigmoid cancer. These findings should have implications for national screening programme extension to under 50s and a call to arms for appropriate identification, staging and treatment of rectosigmoid cancers.

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Section: Discussionmentioning

confidence: 99%

Rising incidence of colorectal cancer in individuals younger than 50 years and increasing mortality from rectosigmoid cancer in England

Lunevičius

Arthur

2021

Colorectal Disease

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“…Similar improvements in disease-free survival were observed at 1, 3, and 5 years with relative risk reductions of 40, 28, and 33%, respectively. 4…”

Section: Rationale and Evidence For Cmementioning

confidence: 99%

“…Similar improvements in disease-free survival were observed at 1, 3, and 5 years with relative risk reductions of 40, 28, and 33%, respectively. 4 A difficulty facing surgeons is the relative contribution of the different components of CME. These are discussed individually.…”

Section: Rationale and Evidence For Cmementioning

confidence: 99%

“…While proponents cite improved oncological outcomes along with the technical elegance of the procedure, critics often doubt these benefits when they are compared against those of a "standard" right hemicolectomy and critics point to an unacceptable risk of serious complications. 4 In this article, we outline the oncological rationale for CME, review the current evidence base, and describe the key mesenteric principles and operative anatomy that underpin the procedure. Finally, we will outline recent technological advances in CME that may improve operative performance and mitigate potential risks.…”

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confidence: 99%

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The Mesentery in Complete Mesocolic Excision

Fletcher

Mišković

2022

Clin Colon Rectal Surg

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“…Accurate positioning of the end effector tool at the target point (operating site). This is key to all precision surgery, not least of all extended lymphatic dissection, which increasingly appears to be improving the overall survival of cancer patients [12][13][14]; 2.…”

Section: Robotic Requirements In Mismentioning

confidence: 99%

Fusing Dexterity and Perception for Soft Robot-Assisted Minimally Invasive Surgery: What We Learnt from STIFF-FLOP

et al. 2021

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In recent years we have seen tremendous progress in the development of robotic solutions for minimally invasive surgery (MIS). Indeed, a number of robot-assisted MIS systems have been developed to product level and are now well-established clinical tools; Intuitive Surgical’s very successful da Vinci Surgical System a prime example. The majority of these surgical systems are based on the traditional rigid-component robot design that was instrumental in the third industrial revolution—especially within the manufacturing sector. However, the use of this approach for surgical procedures on or around soft tissue has come under increasing criticism. The dangers of operating with a robot made from rigid components both near and within a patient are considerable. The EU project STIFF-FLOP, arguably the first large-scale research programme on soft robots for MIS, signalled the start of a concerted effort among researchers to investigate this area more comprehensively. While soft robots have many advantages over their rigid-component counterparts, among them high compliance and increased dexterity, they also bring their own specific challenges when interacting with the environment, such as the need to integrate sensors (which also need to be soft) that can determine the robot’s position and orientation (pose). In this study, the challenges of sensor integration are explored, while keeping the surgeon’s perspective at the forefront of ourdiscussion. The paper critically explores a range of methods, predominantly those developed during the EU project STIFF-FLOP, that facilitate the embedding of soft sensors into articulate soft robot structures using flexible, optics-based lightguides. We examine different optics-based approaches to pose perception in a minimally invasive surgery settings, and methods of integration are also discussed.

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Complete mesocolic excision versus conventional surgery for colon cancer: A systematic review and meta‐analysis

Cited by 39 publications

References 61 publications

Rising incidence of colorectal cancer in individuals younger than 50 years and increasing mortality from rectosigmoid cancer in England

Rising incidence of colorectal cancer in individuals younger than 50 years and increasing mortality from rectosigmoid cancer in England

The Mesentery in Complete Mesocolic Excision

Fusing Dexterity and Perception for Soft Robot-Assisted Minimally Invasive Surgery: What We Learnt from STIFF-FLOP

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