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 < 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.

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.

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.

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

scholarly journals Laparoscopic Wide Mesocolic Excision and Central Vascular Ligation for Carcinoma of the Colon

2016 ◽  
Vol 105 (4) ◽  
pp. 228-234 ◽  
Author(s):  
A. Ehrlich ◽  
M. Kairaluoma ◽  
J. Böhm ◽  
K. Vasala ◽  
H. Kautiainen ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Disease Free Survival ◽  
Oncologic Outcome ◽  
Complete Mesocolic Excision ◽  
Central Vascular Ligation ◽  
Free Survival ◽  
Carcinoma Of The Colon ◽  
Vascular Ligation ◽  
Mesocolic Excision ◽  
Disease Free

Background and Aims: The principle of complete mesocolic excision for colon cancer has been introduced to improve oncologic outcome. However, this approach is scantily discussed for laparoscopic surgery and there is a lack of randomized trials. This study examined oncologic and clinical outcome after laparoscopic wide mesocolic excision and central vascular ligation for colon cancer. Material and Methods: This is a review of prospectively gathered data from a single-institution colorectal cancer database. This study was conducted in the Central Hospital of Central Finland. From January 2003 to December 2011, 222 patients underwent laparoscopic colonic resections with wide mesocolic excision and central vascular ligation in the multimodal setting. The main measures of outcome were cancer recurrence and survival, with early recovery, 30d-mortality and morbidity, reoperation, readmission, and late complications as secondary outcomes. Results: The median follow-up was 5.5 (interquartile range (IQR) = 3.7–8.0) years. The 5-year overall survival for all 222 patients was 80.2% and disease-specific survival was 87.5%, and for those 210 R0-patients with stage I–III disease, 83.9% and 91.3%, respectively. The 5-year disease-free survival was 85.8%: stage I was 94.7%, stage II was 90.8%, and stage III was 75.6% ( p = 0.004). Increasing lymph node ratio significantly decreased the 5-year disease-free survival. Conversion rate to open surgery was 12.2%. Thirty-day mortality was 1.3% and morbidity, 19.7%. Median postoperative hospital stay was 5 (IQR = 3–7) days. Conclusion: Laparoscopic wide mesocolic excision and central vascular ligation for colon cancer resulted in good long-term oncologic outcome. Randomized trials are needed to show that laparoscopic complete mesocolic excision technique would become the standard of care for the carcinoma of the colon.

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