Surgery for Colon Cancer

Hohenberger, Werner; Reingruber, Bertram; Merkel, Susanne

doi:10.1177/145749690309200107

Cited by 49 publications

(48 citation statements)

References 13 publications

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“…these circumstances give support for the results demonstrated, although no firm conclusions can be made due to the retrospective design. the reduced long-term survival seen in this study may seem contradictory to the results published by the Erlangen group (6,7,12). However, central vascular ligation is only part of the cME concept.…”

Section: Methodscontrasting

confidence: 99%

“…Furthermore, no difference in the incidence of recurrences, neither locally nor metastatic, was noted. dIScuSSIon despite little evidence, many guidelines and authors advocate a radical excision of the mesenteric lymphatic drainage in colon cancer (3,5,6,9,12). In this explorative study, we found that wider excision of the bowel in right-sided hemicolectomy was associated with an increased postoperative mortality and an impaired long-term survival.…”

Section: Methodsmentioning

confidence: 99%

“…the concept of complete mesocolic excision (cME) has been introduced in recent years and gained increasing acceptance (6)(7)(8), although not acknowledged as golden standard (9). one of the aspects in this concept is radical excision of the mesocolon by central ligation of the vessels.…”

mentioning

confidence: 99%

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Wide excision in right-sided colon cancer is associated with decreased survival

et al. 2013

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Background and Aims: Nodal involvement is the most important prognostic factor in colon cancer. Although theoretically appealing, it is not known if wider mesenteric excision improves the oncological result. The aim of this retrospective study was to investigate whether wider mesenteric excision yields a superior oncological result. Material and Methods: Depending on the resection length, 333 cases of locally radical right-sided hemicolectomies due to adenocarcinoma were compared for perioperative morbidity and mortality, disease-free survival, and long-term survival. Results: Postoperative mortality was significantly higher in the quartile with the longest resections, p = 0.003. In a multivariate analysis adjusted for age, stage, emergency operation, adjuvant chemotherapy, and year of operation, a negative relationship between resection length and 5-year overall survival was noted, p = 0.01. No differences in the causes of death or in the incidence of local or distant recurrences were noted between groups. Conclusions: Wider excision in right-sided hemicolectomies was not associated with any oncological benefit but an increased postoperative mortality and a decreased 5-year overall survival. These findings may suggest consideration to perform wide mesenteric resections routinely. Further research is warranted to define which patients benefit from wider resections.

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Section: Methodscontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Wide excision in right-sided colon cancer is associated with decreased survival

et al. 2013

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“…Some of the most intriguing results come from Erlangen, Germany, reporting an 18% improvement in 5-year survival following the standardization of colonic resection to include CME. 23 This result seems to be mostly attributable to surgery, as their data originate from a period before instigating adjuvant chemotherapy. 23,24 Although most of these results are based only on regional, noncomparative studies and a multitude of other contributing factors, such as patient characteristics, regional diet and type of adjuvant care received, play a role, the published outcomes suggest probable room for optimizing surgical management.…”

Section: Discussionmentioning

confidence: 97%

“…23 This result seems to be mostly attributable to surgery, as their data originate from a period before instigating adjuvant chemotherapy. 23,24 Although most of these results are based only on regional, noncomparative studies and a multitude of other contributing factors, such as patient characteristics, regional diet and type of adjuvant care received, play a role, the published outcomes suggest probable room for optimizing surgical management. To our knowledge, no readily available studies have been published that specifically address laparoscopic colectomies with CME in the context of long-term survival.…”

Section: Discussionmentioning

confidence: 97%

Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy — analysis of learning curves for a novice minimally invasive surgeon

et al. 2014

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Background: Associated with reduced trauma, laparoscopic colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) has been shown to provide superior nodal yield and offers the prospect of better oncological outcomes.Methods: All oncologic laparoscopic right colon resections with CME performed by a single surgeon since the beginning of his surgical practice were retrospectively analyzed for operative duration and perioperative outcomes. Results:The study included 81 patients. The average duration of surgery was 220.0 (range 206-233) minutes. The initial durations of about 250 minutes gradually decreased to less than 200 minutes in an inverse linear relationship (y = -0.58x × 248). The major complication rate was 3.6% ± 4.2% and the average nodal yield was 31.3 ± 4.1. CumulativeSum analysis showed acceptable complication rates and oncological results from the beginning of surgeon's laparoscopic career. Conclusion:Developing laparoscopic skills can provide acceptable outcomes in advanced right hemicolectomy for a surgeon who primarily trained in open colorectal surgery. Operative duration is nearly triple that reported for conventional laparoscopic right hemicolectomy. The slow operative duration learning curve without a plateau reflects complex anatomy and the need for careful dissection around critical structures. Should one wish to adopt this strategy either based on some available evidence of superiority or with intention to participate in research, one has to change the view of right hemicolectomy being a rather simple case to being a complex, lengthy laparoscopic surgery.Contexte : La chirurgie du côlon par laparoscopie, qui réduit les traumatismes, est une solution de rechange à la chirurgie ouverte. De plus, il a été démontré que l'excision mésocolique complète (EMC) optimise le curage ganglionnaire et offre la perspective de meilleurs résultats oncologiques. Méthodes :On a examiné rétrospectivement la durée de l'opération et les résultats périopératoires de toutes les résections du côlon droit réalisées par laparoscopie avec EMC pratiquées par un seul chirurgien depuis le début de sa carrière.Résultats : L'étude a été menée auprès de 81 patients. La durée moyenne de l'intervention chirurgicale était de 220 minutes (intervalle de 206 à 233 minutes). Au début, l'intervention durait environ 250 minutes; avec le temps, sa durée a progressivement diminué de sorte qu'à la fin, elle était de moins de 200 minutes, d'après une relation linéaire négative (y = -0,58x × 248). Le taux de complications graves s'est établi à 3,6 % ± 4,2 % et le nombre moyen de noeuds lymphatiques excisés a été de 31,3 ± 4,1. En utilisant la méthode d'analyse des sommes cumulées, on a observé un taux de complications et des résultats oncologiques acceptables depuis le début de la carrière du chirurgien en laparoscopie. Conclusion :En perfectionnant sa technique laparoscopique, un chirurgien formé principalement en chirurgie colorectale ouverte peut produire des résultats acceptables dans les cas d'hé...

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