Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review

Sica, Giuseppe; Vinci, Danilo; Siragusa, Leandro; Sensi, Bruno; Guida, Andrea Martina; Bellato, Vittoria; García-Granero, Álvaro; Pellino, Gianluca

doi:10.1007/s00464-022-09548-5

Cited by 21 publications

(24 citation statements)

References 134 publications

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“…Adequate patient selection, combined with an appropriate surgical procedure, is reported to result in a low risk of both early and late complications after surgery, when the postoperative recovery is prompt [26][27][28]. Timely detection and treatment of complications is also very relevant.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory laparoscopic colectomies: a systematic review

et al. 2023

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Aim Ambulatory laparoscopic colectomy (ALC), meaning discharge within 24 h of surgical colonic resection, has recently been proposed in a few, selected patients. This systematic review was performed with the aim of reviewing protocols for ALC and assessing feasibility, safety and outcomes after ALC. Method A PRISMA‐compliant systematic review and pooled analysis was performed searching all English studies published until October 2022 in PubMed, Cochrane Library, Web of Science (PROSPERO, CRD42022334463). Inclusion criteria were original articles including patients undergoing ALC, specifying at least one outcome of interest. Exclusion criteria were articles reporting a robotic‐assisted procedure; unable to retrieve patient data from articles; the same patient series included in different studies. Primary outcomes were success, overall complications and readmission rates. Secondary outcomes included mortality and specific complications such us surgical site infection, anastomotic leak, ileus, bleeding, rate of ALC acceptance, and unscheduled consultation and reoperation rate. Results Among 1087 studies imported for screening, 11 were included (1296 patients). The success rate was 47% with an overall morbidity of 14%. Readmission and reoperation rates were 5% and 1%, respectively. No mortality was recorded. Protocols of ALC differ significantly among published studies. Conclusions Overall, ALC appears to be safe and feasible in selected cases with an acceptable success rate and a low risk of readmission after hospital discharge. Future studies should evaluate patients' benefits and discharge criteria, as well as uniformity and standardization of eligibility criteria. This systematic review may help inform on ALC adoption in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Ambulatory laparoscopic colectomies: a systematic review

et al. 2023

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“…Surgeries were performed following oncological principles if not contraindicated. Patients with right colon cancer were randomly assigned to complete a mesocolic excision as part of an undergoing study [ 20 ]. Peri-operative care followed the ERAS pathway, when applicable, for the whole study period [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic

Pirozzi

Siragusa

Baldini

et al. 2023

JCM

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The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the Covid-19 pandemic (1 March 2020–28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018–29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions.

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“…A recent systematic review of 99 studies reporting the outcomes of radical colectomy for right colon tumours identified six different surgical techniques for which there were 35 unique definitions (Table 1). 8 The following manoeuvres were included in some or all of the different definitions:…”

Section: Terminologymentioning

confidence: 99%

“…Although Hohenberger's original description of CME for right colon tumours required a right medial visceral rotation (Cattell-Brasch manoeuvre), more recent descriptions of CME have been modified to more closely align with D3 lymphadenectomy (according to the definition of the Japanese Society for Cancer of the Colon and Rectum, JSCCR) where dissection is limited to the anterior aspect of the SMV and in some descriptions the SMA. 8,[11][12][13] CVL, which requires exposure of the SMA and SMV in order to ligate the ileocolic artery and vein at their origins, may or may not imply resection of the lymph nodes along the SMA and SMV. Unlike the imprecise Western CME literature, the JSCCR defines extent of lymphadenectomy for colon tumours according to anatomical lymph node groups as follows: D1: excision of paracolic lymph nodes along the marginal artery.…”

Section: Central Vascular Ligation and Extended Lymphadenectomymentioning

confidence: 99%

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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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Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review

Cited by 21 publications

References 134 publications

Ambulatory laparoscopic colectomies: a systematic review

Ambulatory laparoscopic colectomies: a systematic review

Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic

Complete mesocolic excision for colon cancer: current status and controversies

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