Safety, quality and effect of complete mesocolic excision <i>vs</i> non‐complete mesocolic excision in patients with colon cancer: a systemic review and meta‐analysis

Wang, C; Gao, Zhidong; Shen, Kai; Shen, Zhanlong; Jiang, Kewei; Liang, Bin; Yin, Ming; Yang, Xiaodong; Wang, S; Ye, Y

doi:10.1111/codi.13900

Cited by 119 publications

(82 citation statements)

References 38 publications

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“…In order to decrease the risk of guarantee-time bias, which weakened the results of many studies evaluating the use of adjuvant therapy in stage II colon cancer, [23][24][25]38 40 and these results were further confirmed by a recent meta-analysis. 41 rate of MSI-high colon cancers in the study population (7.5% and 8.8% in the adjuvant chemotherapy and observation group, respectively), while MSI phenotype is known to account for 12% to 20% of colon cancers in Western countries. 42 MSI status is probably underreported given present MSI rates are in line with previous NCDB publications.…”

Section: Discussionmentioning

confidence: 91%

Survival impact of adjuvant chemotherapy in patients with stage IIA colon cancer: Analysis of the National Cancer Database

Achilli

Crippa

Grass

et al. 2020

Intl Journal of Cancer

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Utility of adjuvant chemotherapy for stage II cancer remains a matter of debate. Clinical guidelines suggest adjuvant chemotherapy for stage II tumors with high-risk features, in particular T4 tumors. However, limited consensus exists regarding the importance of other high-risk features (lymphovascular or perineural invasion, microsatellite instability). Our study aimed to investigate the impact of adjuvant chemotherapy for stage IIA (T3N0) colon cancer patients. Patients who underwent colectomy for stage IIA colon adenocarcinoma (2010-2015) were identified in the National Cancer Database (NCDB) and divided in two groups based on receipt of adjuvant chemotherapy vs observation. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed to compare overall survival between the two groups. Subgroup analysis of patients with specific high-risk features LVI, PNI and MSI was performed. Among 46 688 surgical patients with stage IIA colon adenocarcinoma 5937 (12.7%) received adjuvant chemotherapy, while 40 751 (87.3%) were observed. Five-year IPTW-adjusted survival was higher in the adjuvant chemotherapy group (79.7% [95% CI 79.1, 80.2]) compared to the observation group (70.3% [95% CI 69.7, 70.9]). Patients with high-risk pathological features showed an estimated 5-year survival benefit of 11.3% (78.2% [95% CI 77.4, 79.1] vs 66.9% [95% CI 65.9, 67.8]) when treated with adjuvant chemotherapy. This NCDB analysis revealed a survival benefit for patients with stage IIA colon adenocarcinoma and high-risk features that were treated with adjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 91%

Survival impact of adjuvant chemotherapy in patients with stage IIA colon cancer: Analysis of the National Cancer Database

Achilli

Crippa

Grass

et al. 2020

Intl Journal of Cancer

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“…In patients with cancer, lymphadenectomy is mandatory, and splenic flexure mobilization and complete mesocolic excision are often performed 30‐32 . These specificities seem to have an impact on the occurrence of postoperative outcomes, like ileus 33‐38 . It could also explain the higher rate of urinary retention in patients with cancer.…”

Section: Discussionmentioning

confidence: 99%

Impact of surgical indication on patient outcomes and compliance with enhanced recovery program for colorectal surgery: A Francophone multicenter retrospective analysis

Crignis

Slim

Cotte

et al. 2020

Journal of Surgical Oncology

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Background and Objective The impact of surgical indication on compliance with enhanced recovery program (ERP) and on outcomes has never been assessed. This study aims to assess the impact of surgical indication (malignant vs benign) on postoperative outcomes and ERP compliance. Methods A multicenter nationwide database was analyzed. Patients who underwent colorectal surgery for benign disease and those who underwent colorectal surgery for cancer were compared. Inclusion criteria were elective colorectal resection with anastomosis. ERP components, postoperative morbidity, and hospital length of hospital stay data were collected. Results Among the 6472 patients registered in the database between October 2012 and June 2018, 4528 patients were included; 2647 in the malignant group and 1881 in the benign group. The ERP compliance over 70% was not different between groups. Postoperative morbidity rate was higher in the malignant group (22.5% vs 19.3%; P = .009) but not confirmed in multivariate analysis. Patients in the malignant group were more often readmitted after discharge, 6.6% vs 4.6% (P = .004). The mean LOS was 6.3 ± 5.0 days in the malignant group and 5.4 ± 4.7 days in the benign group (P < .001). Conclusions Indication for colorectal surgery did not significantly influence peri‐operative management and postoperative major complications, in patients managed within an enhanced recovery program.

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“…The uptake of the CME + CVL method for right‐sided cancers has not been as popular in the West as TME has been for rectal cancers; this is perhaps due to its perceived higher risk of complications and technical challenges when resecting around such potentially variable vascular anatomy 11 . Traditionally, in Eastern countries such as South Korea 12 and Japan, the notion of resecting along the embryological planes whilst harvesting the lymph nodes down to its central arterial root has been a longstanding surgical method practiced by the majority of cancer surgeons.…”

Section: East Vs Westmentioning

confidence: 99%

Minimally invasive complete mesocolic excision for right colon cancer

Park

Lee

Kim

2020

Annals of Gastroent Surgery

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The burden of colorectal cancer is increasing worldwide, and is currently the third most commonly diagnosed cancer and the fourth cause of cancer-related deaths. 1 The incidence of colorectal cancer is considered a marker of cancer transition, with rapid societal and economic advances resulting in its increase. The doubling of colorectal cancer in East Asia, such as in South Korea, 2 Japan, 3 and China, over the last two decades mirrors the economic growth in these countries.Right-sided colon cancers are described as cancer of the cecum, the ascending colon up to the hepatic flexure and the proximal part of the transverse colon. Embryologically, the right AbstractComplete mesocolic excision (CME) with central vascular ligation (CVL) follows the same principles as the total mesorectal excision (TME) in the rectum of following the embryological planes for right-sided cancers. The number of lymph nodes yielded increased with a resultant improvement in the oncological outcomes and by reducing local recurrence rates. Hohenberger's radical CME and CVL and the East's modified CME with D3 lymphadenectomy, which traditionally followed the embryological plane dissection for most of its intraabdominal cancer resection, have both shown to harvest significantly higher number of lymph nodes leading to a higher overall survival rate than the traditional right hemicolectomies of the West. To achieve the oncologically superior excision of the CME, awareness of the significant vascular anatomical variation will enhance the precision of the oncosurgery as well as minimize the risk of vascular complications. There has been an increasing body of evidence emerging on the safety of minimally invasive surgery (MIS); both its oncological safety as well as complication rates in the hands of expert and trained surgeons. The surgical technique of a CME right hemicolectomy is described step by step to aid standardization. There is mounting evidence that CME + CVL/ D3 improves survival in patients with colon cancer. Whilst the technical aspect of MIS is more challenging than the left, with a standardized technique and systematic teaching method, safety and benefits for patients can be achieved. K E Y W O R D S colon malignancy, colorectal cancer, D3 lymphadenectomy, mesocolic excision, minimally invasive surgery [Correction added on 25 April 2020, after the first online publication: Corresponding author was changed from Hyunmi Park to Seon-Hahn Kim.] | 235 PARK et Al.

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Safety, quality and effect of complete mesocolic excision vs non‐complete mesocolic excision in patients with colon cancer: a systemic review and meta‐analysis

Abstract: Limited evidence suggests that CME is a more effective strategy for improving specimen quality and survival but with a higher complication rate.

Cited by 119 publications

References 38 publications

Survival impact of adjuvant chemotherapy in patients with stage IIA colon cancer: Analysis of the National Cancer Database

Survival impact of adjuvant chemotherapy in patients with stage IIA colon cancer: Analysis of the National Cancer Database

Impact of surgical indication on patient outcomes and compliance with enhanced recovery program for colorectal surgery: A Francophone multicenter retrospective analysis

Minimally invasive complete mesocolic excision for right colon cancer

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