Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial

Xu, Lai; Su, Xiangqian; He, Zengyou; Zhang, Chenghai; Lu, Junliang; Chen, Lei; Zhang, Guannan; Feng, Bo; Zang, Lu; Ma, Junjun; Sun, Yueming; Feng, Yifei; Ji, Dongjian; Du, Xiaohui; He, Changzheng; Fu, Ze; Chi, Pan; Huang, Ying; Jiang, Weizhong; Wang, Ziqiang; Wu, Qingbin; Zhong, Ming; Yu, Minhao; Wu, Aiwen; Chen, Pengju; Zhu, Aiguo; Guan, Wen‐Long; Wu, Bin; Li, Fēi; Li, Ang; Xu, Jianmin; He, Guodong; Kang, Liang; He, Xiaowen; Suo, Jian; Wang, Daguang; Deng, Haijun; Wang, Yanan; Ye, Yingjiang; Shen, Kai; Lin, Guole; Yao, Hongwei; Qiu, Huizhong; Ding, Kefeng; Xu, Tao; Liang, Zhiyong; Zhou, Weixun; Xue, Huadan; Li, Bin; Zhang, Zhongtao; Zheng, Minhua; Xiao, Yi

doi:10.1016/s1470-2045(20)30685-9

Cited by 119 publications

(130 citation statements)

References 29 publications

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“…Similarly, some authors have raised concerns of a major risk of vascular injury when CME started to become surgically widespread [44]. This concern was confirmed by preliminary results of an ongoing randomized, controlled, phase 3 superiority trial on laparoscopic right colectomy with CME versus D2 lymphadenectomy [45]. However, it has not been confirmed in our present review of robotic series, as only one author described two cases of minor vascular injury, both of which were successfully repaired and did not require conversion to open surgery.…”

Section: Discussionmentioning

confidence: 92%

Updates on Robotic CME for Right Colon Cancer: A Qualitative Systematic Review

Petz

Borin

Fumagalli

2021

JPM

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Background. Complete mesocolic excision (CME) is a surgical technique introduced with the aim of ameliorating the oncologic results of colectomy. Various experiences have demonstrated favorable oncologic results of CME in comparison with standard colectomy, in which the principles of CME are not respected. The majority of the literature refers to open or laparoscopic CME. This review analyses current evidence regarding robotic CME for right colectomy. Methods. An extensive Medline (Pub Med) search for relevant case series, restricted to papers published in English, was performed, censoring video vignettes and case reports. Results. Fourteen studies (ten retrospective, four comparative series of robotic versus laparoscopic CME) were included, with patient numbers ranging from 20 to 202. Four different approaches to CME are described, which also depend on the robotic platform utilized. Intraoperative and early clinical results were good, with a low conversion and anastomotic leak rate and a majority of Clavien–Dindo complications being Grades I and II. Oncologic adequacy of the surgical specimens was found to be good, although a homogeneous histopathologic evaluation was not provided. Conclusions. Further large studies are warranted to define long-term oncologic results of robotic right colectomy with CME and its eventual benefits in comparison to laparoscopy.

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Section: Discussionmentioning

confidence: 92%

Updates on Robotic CME for Right Colon Cancer: A Qualitative Systematic Review

Petz

Borin

Fumagalli

2021

JPM

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“…Today, all colorectal cancer resections are performed or supervised by trained colorectal surgeons in public hospitals with a catchment area of 300 000 or more. In our opinion this set-up ensures that CME can be performed safely as reported [23]. From 2015, we have intended to perform all extended resections as laparoscopic CME.…”

Section: Clinical Contextmentioning

confidence: 99%

“…To what extent this issue contributes to the outcome is not possible to determine as the non-CME group was considered the standard of resection performed in most Danish hospitals during the study period without any information on the anatomical level of vascular division. It is hoped that upcoming studies [23][24][25] might answer this question.…”

Section: Limitationsmentioning

confidence: 99%

Recurrence after complete mesocolic excision for right‐sided colon cancer: post hoc sensitivity analyses—early recurrence, surgery by specialist and dissection in the mesocolic plane

2021

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Complete mesocolic excision (CME) and similar surgical principles have been shown to be associated with better oncological outcome [1][2][3][4][5][6] with our recently presented data showing a causal treatment effect of CME on the risk of recurrence after right-sided colon cancer resection [7,8]. Colleagues have questioned whether our results were biased by potentially undiagnosed disseminated disease at the time of surgery or by resections in the non-CME group performed by a non-specialist. Furthermore, it has been questioned whether the effect of CME was solely caused by the higher proportion of dissection in the

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“…Transanal haemorrhoidal dearterialization (THD) is a surgical nonresective procedure for the treatment of haemorrhoids. THD is a combination of dearterialization and mucopexis, and is associated with less severe postoperative pain and faster recovery than excisional haemorrhoidectomy [1][2][3][4][5]. After the running suture is fashioned, including the artery at the end of the suture, the two ends of the thread can be pulled and tied, forcing the running of the thread through the mucosa and the closure of the artery.…”

Section: Dear Sirmentioning

confidence: 99%