Survival after Complete Mesocolic Excision (CME) for Right Sided Coloncancer Compared to Standard Surgery

Abstract

Abstract:Purpose: Complete mesocolic excision for right sided colon cancer is a complex operation that might offer a survival benefit. However, studies comparing CME to standard surgery have not been published so far.Methods: One-hundred-seven patients were operated at the discretion of the surgeon either according to principles of complete mesocolic excision (CME-group, n=69) or received a standard right hemicolectomy (non-CME group, n=38). The type of surgery was prospectively recorded.Results: Patients in the non-CME group were significantly older (67,9 vs.78,1 p<0,001) and had fewer adjuvant chemotherapies in stage III (94,7 vs. 60,0% p=0,02). For the combined analysis of stages I-III actuarial 5-year overall-, recurrence free-and tumor specific survival was significantly better for the CME group (OS 89,4% vs. 71,5%, p=0,011; RFS 83,8% vs. 70,3% p=0,035; TSS 93,8% vs. 78,0% p=0,049). Conclusion:The data suggest a survival benefit for complete mesocolic excision in the treatment of right sided colon cancer. However, the data needs to be interpreted with caution because of the uneven distribution of age and number chemotherapies. The results of the large multicentre trial which is currently going on among German certified cancer is expected to further clarify this issue.

Complete mesocolic excision for right hemicolectomy: an updated systematic review and meta-analysis

“…TNM stages ranged between I and III. Three studies included only laparoscopic surgery [ 15 , 19 , 20 ], and one study only open surgery [ 30 ]. Newcastle–Ottawa Scale scores ranged between 6/9 and 8/9.…”

“…All studies comparing CME versus non-CME reported a statistically significant increase in harvested lymph nodes in favour of the CME technique, with mean values ranging between 22.6 and 57.9 lymph nodes for the CME group and between 14.0 and 50.4 lymph nodes for the non-CME group [ 15 , 17 , 19 – 24 , 30 ]. Meta-analysis found that CME increased the number of harvested lymph nodes by 9 lymph nodes when compared to non-CME (9 studies, 3955 patients, MD 9.03, 95% CI 5.36–12.71, p < 0.00001, I 2 95%) (Fig.…”

“…Two studies reported the incidence of reoperation, which ranged between 5.3% and 7.5% for the non-CME group, and between 7.2% and 8.9% for the CME group. These differences were not statistically significant [ 24 , 30 ]. Pooled analysis did not show any difference in terms of the incidence of reoperation between the CME and the non-CME group (2 studies, 1111 patients, OR 1.24, 95% CI 0.81–1.92, p = 0.32, I 2 0%) (Fig.…”

Open Right Hemicolectomy Is a Safe and Suitable Procedure for Surgical Training: A Comparative Study With 133 Patients

“…In recent years, exact dissection along the embryological layer with radical lymphadenectomy up to the mesenteric vessels (complete mesocolic excision (CME)) has become a focus of attention (3). Analogous to total mesorectal excision (TME) for rectal cancer, this surgical procedure has significantly improved the oncological outcome compared with conventional lymphadenectomy (3)(4)(5). However, CME is a technically demanding procedure.…”

Die komplette mesokolische Exzision beim rechtsseitigen Kolonkarzinom – welche Rolle spielen die zentralen Lymphknoten?

“…Hohenberger stellte dieses Konzept der CME 2009 vor und konnte damit eine tumorspezifische 5-Jahres-Überlebensrate von 89 % in den Stadien UICC I-III erreichen. In einem prospektiven, nichtrandomisierten Vergleich konnte unsere Arbeitsgruppe diese Daten bestätigen [6]. Unterstützt wurde das Konzept zudem durch Publikationen, die eine Korrelation zwischen intakten Grenzlamellen und der Prognose zeigen konnten.…”