Morphometric analysis and lymph node yield in laparoscopic complete mesocolic excision performed by supervised trainees

2014 ◽  
Vol 101 (11) ◽  
pp. 1460-1467 ◽  
Author(s):  
N. P. West ◽  
R. H. Kennedy ◽  
T. Magro ◽  
G. Luglio ◽  
S. Sala ◽  
...  
Keyword(s):  
Lymph Node ◽  
Morphometric Analysis ◽  
Complete Mesocolic Excision ◽  
Lymph Node Yield ◽  
Mesocolic Excision ◽  
Node Yield

Complete Mesocolic Excision With Central Vascular Ligation Produces an Oncologically Superior Specimen Compared With Standard Surgery for Carcinoma of the Colon

2010 ◽  
Vol 28 (2) ◽  
pp. 272-278 ◽  
Author(s):  
Nicholas P. West ◽  
Werner Hohenberger ◽  
Klaus Weber ◽  
Aristoteles Perrakis ◽  
Paul J. Finan ◽  
...  
Keyword(s):  
Lymph Node ◽  
Colonic Cancer ◽  
Complete Mesocolic Excision ◽  
Central Vascular Ligation ◽  
Lymph Node Yield ◽  
Carcinoma Of The Colon ◽  
Vascular Ligation ◽  
Standard Specimens ◽  
Mesocolic Excision ◽  
Node Yield

Purpose The plane of surgery in colonic cancer has been linked to patient outcome although the optimal extent of mesenteric resection is still unclear. Surgeons in Erlangen, Germany, routinely perform complete mesocolic excision (CME) with central vascular ligation (CVL) and report 5-year survivals of higher than 89%. We aimed to further investigate the importance of CME and CVL surgery for colonic cancer by comparison with a series of standard specimens. Methods The fresh photographs of 49 CME and CVL specimens from Erlangen and 40 standard specimens from Leeds, United Kingdom, for primary colonic adenocarcinoma were collected. Precise tissue morphometry and grading of the plane of surgery were performed before comparison to histopathologic variables. Results CME and CVL surgery removed more tissue compared with standard surgery in terms of the distance between the tumor and the high vascular tie (median, 131 v 90 mm; P < .0001), the length of large bowel (median, 314 v 206 mm; P < .0001), and ileum removed (median, 83 v 63 mm; P = .003), and the area of mesentery (19,657 v 11,829 mm2; P < .0001). In addition, CME and CVL surgery was associated with more mesocolic plane resections (92% v 40%; P < .0001) and a greater lymph node yield (median, 30 v 18; P < .0001). Conclusion Surgeons in Erlangen routinely practicing CME and CVL surgery remove more mesocolon and are more likely to resect in the mesocolic plane when compared with standard excisions. This, along with the associated greater lymph node yield, may partially explain the high 5-year survival rates reported in Erlangen.

scholarly journals Robotic complete mesocolic excision with central vascular ligation for right colonic tumours – a propensity score-matching study comparing with standard laparoscopy

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
J S Khan ◽  
A Ahmad ◽  
M Odermatt ◽  
D G Jayne ◽  
N Z Ahmad ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Operative Time ◽  
Complete Mesocolic Excision ◽  
Central Vascular Ligation ◽  
Lymph Node Yield ◽  
Vascular Ligation ◽  
Mesocolic Excision ◽  
Node Yield ◽  
Disease Free

Abstract Background Laparoscopic complete mesocolic excision (CME) of the right colon with central vascular ligation (CVL) is a technically demanding procedure. This study retrospectively evaluated the feasibility, safety and oncological outcomes of the procedure when performed using the da Vinci® robotic system. Methods A prospective case series was collected over 3 years for patients with right colonic cancers treated by standardized robotic CME with CVL using the superior mesenteric vessels first approach. The CME group was compared to a 2 : 1 propensity score-matched non-CME group who had conventional laparoscopic right colectomy with D2 nodal dissection. Primary outcomes were total lymph node harvest and length of specimen. Secondary outcomes were operative time, postoperative complications, and disease-free and overall survival. Results The study included 120 patients (40 in the CME group and 80 in the non-CME group). Lymph node yield was higher (29 versus 18, P = 0.006), the specimen length longer (322 versus 260 mm, P = 0.001) and median operative time was significantly longer (180 versus 130 min, P &lt; 0.001) with robotic CME versus laparoscopy, respectively. Duration of hospital stay was longer with robotic CME, although not significantly (median 6 versus 5 days, P = 0.088). There were no significant differences in R0 resection rate, complications, readmission rates and local recurrence. A trend in survival benefit with robotic CME for disease-free (P = 0.0581) and overall survival (P = 0.0454) at 3 years was documented. Conclusion Robotic CME with CVL is feasible and, although currently associated with a longer operation time, it provides good specimen quality, higher lymph node yield and acceptable morbidity, with a disease-free survival advantage.

scholarly journals Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis

2021 ◽  
Author(s):  
G. Anania ◽  
R. J. Davies ◽  
F. Bagolini ◽  
N. Vettoretto ◽  
J. Randolph ◽  
...  
Keyword(s):  
Lymph Node ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Operating Time ◽  
Disease Free Survival ◽  
Complete Mesocolic Excision ◽  
Right Hemicolectomy ◽  
Oncologic Outcomes ◽  
Lymph Node Yield ◽  
Node Yield

Abstract Background The introduction of complete mesocolic excision (CME) for right colon cancer has raised an important discussion in relation to the extent of colic and mesenteric resection, and the impact this may have on lymph node yield. As uncertainty remains regarding the usefulness of and indications for right hemicolectomy with CME and the benefits of CME compared with a traditional approach, the purpose of this meta-analysis is to compare the two procedures in terms of safety, lymph node yield and oncological outcome. Methods We performed a systematic review of the literature from 2009 up to March 15th, 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two hundred eighty-one publications were evaluated, and 17 met the inclusion criteria and were included. Primary endpoints analysed were anastomotic leak rate, blood loss, number of harvested lymph nodes, 3- and 5-year oncologic outcomes. Secondary outcomes were operating time, conversion, intraoperative complications, reoperation rate, overall and Clavien–Dindo grade 3–4 postoperative complications. Results In terms of safety, right hemicolectomy with CME is not inferior to the standard procedure when comparing rates of anastomotic leak (RR 0.82, 95% CI 0.38–1.79), blood loss (MD −32.48, 95% CI −98.54 to −33.58), overall postoperative complications (RR 0.82, 95% CI 0.67–1.00), Clavien–Dindo grade III–IV postoperative complications (RR 1.36, 95% CI 0.82–2.28) and reoperation rate (RR 0.65, 95% CI 0.26–1.75). Traditional surgery is associated with a shorter operating time (MD 16.43, 95% CI 4.27–28.60) and lower conversion from laparoscopic to open approach (RR 1.72, 95% CI 1.00–2.96). In terms of oncologic outcomes, right hemicolectomy with CME leads to a higher lymph node yield than traditional surgery (MD 7.05, 95% CI 4.06–10.04). Results of statistical analysis comparing 3-year overall survival and 5-year disease-free survival were better in the CME group, RR 0.42, 95% CI 0.27–0.66 and RR 0.36, 95% CI 0.17–0.56, respectively. Conclusions Right hemicolectomy with CME is not inferior to traditional surgery in terms of safety and has a greater lymph node yield when compared with traditional surgery. Moreover, right-sided CME is associated with better overall and disease-free survival.

852 Complete Mesocolic Excision (CME) Versus Conventional Surgery for Colon Cancer: A Systematic Review and Metaanalysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J Crane ◽  
M Hamed ◽  
J Borucki ◽  
A El-Hadi ◽  
I Shaikh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Colon Cancer ◽  
Overall Survival ◽  
Complete Mesocolic Excision ◽  
R0 Resection ◽  
Conventional Surgery ◽  
Lymph Node Yield ◽  
Mesocolic Excision ◽  
Node Yield ◽  
Disease Free

Abstract Introduction Complete mesocolic excision (CME) lacks consistent data to advocate operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analyses, analysing peri-operative, pathological, and oncological outcomes. Method A systematic literature review was registered with PROSPERO and carried out using PRISMA guidelines. Outcomes reviewed included lymph node yield, R0, disease free and overall survival at five years. Results 3039 citations were identified; 148 studies underwent full-text reviews and 34 matched our inclusion criteria. There were no significant differences between the CME and non-CME group in overall complications (13.8% vs.13.8%) or anastomotic leak (1.3% vs. 1.7%). Nodal yield was higher in the CME group, 18.7 compared to 13.6 in the non-CME group. The rate of R0 resection was 96.8% in CME compared to 95.5%. Overall survival at five years was higher in the CME group 77.8% compared to 69.7% in non-CME group. Conclusions CME for colon cancer was associated with no significant differences in morbidity and mortality, better lymph node yield and R0 resection compared to the non-CME group. Our meta-analysis further supported this demonstrating an improved overall and disease-free survival at five years in the CME group compared to the non-CME group.

Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

2021 ◽  
pp. 1-8
Author(s):  
K Devaraja ◽  
K Pujary ◽  
B Ramaswamy ◽  
D R Nayak ◽  
N Kumar ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Neck Dissection ◽  
Squamous Cell ◽  
Neck Squamous Cell Carcinoma ◽  
En Bloc ◽  
Lymph Node Yield ◽  
Node Yield

Abstract Background Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. Methods This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. Results From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). Conclusion Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

scholarly journals A High Lymph Node Yield is Associated with Prolonged Survival in Elderly Patients Undergoing Curative Gastrectomy for Cancer: A Dutch Population-Based Cohort Study

2017 ◽  
Vol 24 (8) ◽  
pp. 2213-2223 ◽  
Author(s):  
Hylke J. F. Brenkman ◽  
Lucas Goense ◽  
Lodewijk A. Brosens ◽  
Nadia Haj Mohammad ◽  
Frank P. Vleggaar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lymph Node ◽  
Elderly Patients ◽  
Population Based ◽  
Prolonged Survival ◽  
Dutch Population ◽  
Curative Gastrectomy ◽  
Lymph Node Yield ◽  
High Lymph Node ◽  
Node Yield

Accuracy of the Lymph Node Yield in Surgery for Papillary Thyroid Cancer in Children

2021 ◽  
Author(s):  
Ava Yap ◽  
Amy Shui ◽  
Jessica Gosnell ◽  
Chiung-Yu Huang ◽  
Julie Ann Sosa ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Papillary Thyroid Cancer ◽  
Papillary Thyroid ◽  
Lymph Node Yield ◽  
Cancer In Children ◽  
Node Yield

Quality of Pathology Reporting Impacts on Lymph Node Yield in Colon Cancer

2007 ◽  
Vol 25 (4) ◽  
pp. 463-463 ◽  
Author(s):  
Nicholas A. Rieger ◽  
Frances S. Barnett ◽  
James W.E. Moore ◽  
Sumitra S. Ananda ◽  
Matthew Croxford ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Node Yield ◽  
Pathology Reporting ◽  
Node Yield
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