Extended Versus Standard Complete Mesocolon Excision in Sigmoid Colon Cancer

Abstract

The aim of this study was to evaluate whether extended complete mesocolic excision (e-CME) for sigmoid colon cancer improves oncological outcomes without compromising morbidity or functional results. Background: In surgery for cancer of the sigmoid colon and upper rectum, s-CME removes the lymphofatty tissue surrounding the inferior mesenteric artery (IMA), but not the lymphofatty tissue surrounding the portion of the inferior mesenteric vein that does not run parallel to the IMA. Evidence about the safety and efficacy of extending CME to include this tissue is lacking.Methods: This single-blind study randomized sigmoid cancer patients at 4 centers to undergo e-CME or s-CME. The primary outcome was the total number of lymph nodes harvested. Secondary outcomes included disease-free and overall survival at 2 years, morbidity, and bowel and genitourinary function. Clinicaltrials.gov: NCT03107650. Results: We analyzed 93 patients (46 e-CME and 47 s-CME). Perioperative outcomes were similar between groups. No differences between groups were found in the total number of lymph nodes harvested [21 (interquartile range, IQR, 14-29) in e-CME vs 20 (IQR, 15-27) in s-CME, P ¼ 0.873], morbidity (P ¼ 0.829), disease-free survival (P ¼ 0.926), or overall survival (P ¼ 0.564). The extended specimen yielded a median of 1 lymph node (range, 0-6), none of which were positive. Bowel function recovery was similar between arms at all timepoints. Males undergoing e-CME had worse recovery of urinary function (P ¼ 0.026). Conclusion: Extending lymphadenectomy to include the IMV territory did not increase the number of lymph nodes or improve local recurrence or survival rates.

Does the level of inferior mesenteric artery ligation affect short-term and long-term outcomes of patients with sigmoid colon cancer or rectal cancer? A single-center retrospective study

“…Actually in the study by Mari GM et al, both LT and HT led to impaired sexual and urinary performance, while sexual and urinary performance after LT improved more significantly than that after HT [ 37 ]. However, in two other studies, HT was not significantly different from LT in terms of male genitourinary function of patients with sigmoid colon cancer [ 39 , 40 ]. Interestingly, LT was not significantly different from HT in terms of male genitourinary function, while LT was superior to HT in terms of sexual and urinary performance.…”

Comparison of Postoperative Outcome and Prognosis Among Laparoscopic Left Colectomy and Laparoscopic Sigmoidectomy in Sigmoid Colon Cancer Patients: A Propensity Score Matching Study

“…The different effects of laparoscopic surgery vs open surgery in CRC were explored, 22 and an association between CRC and specified surgery in terms of prognosis was found. 23 In a randomized-controlled trial comparing extended complete mesocolic excision (CME) vs standard CME in SCC, Planellas P et al 24 found the total number of lymph nodes, DFS, and OS had no significant difference in the comparison of the two surgical procedures. Our results were similar with their outcomes.…”

Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review

“…Several authors have attempted to also assign an oncological role to this procedure, asserting that it can substantially increase the number of resected lymph nodes along the root of the IMV, potentially influencing both the survival and the local recurrence rate [ 47 , 48 ]. However, the published data have shown contrasting results, likely due to the heterogeneity in the patient population, leaving the oncological significance of the IMV ligation uncertain [ 49 , 50 ]. Only one recent multicenter randomized controlled trial explored the effects of an extended lymphadenectomy in sigmoid colon cancer [ 50 ].…”

“…However, the published data have shown contrasting results, likely due to the heterogeneity in the patient population, leaving the oncological significance of the IMV ligation uncertain [ 49 , 50 ]. Only one recent multicenter randomized controlled trial explored the effects of an extended lymphadenectomy in sigmoid colon cancer [ 50 ]. Their findings indicated that including the lymphatic area around the IMV did not result in a higher total node count or a greater detection of positive nodes.…”