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Du WF, Liang TS, Guo ZF, Li JJ, Yang CG. Comparison of outcomes of laparoscopic-assisted and total laparoscopic right hemicolectomy for right-sided colon cancer. World J Gastrointest Surg 2025; 17:100476. [PMID: 40291870 PMCID: PMC12019061 DOI: 10.4240/wjgs.v17.i4.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 01/13/2025] [Accepted: 02/18/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Colon cancer is a significant health issue in China, with high incidence and mortality rates. Surgical resection remains the primary treatment, with the introduction of complete mesocolic excision in 2009 improving precision and outcomes. Laparoscopic techniques, including laparoscopic-assisted right hemicolectomy (LARH) and total laparoscopic right hemicolectomy (TLRH), have further advanced colon cancer treatment by reducing trauma, blood loss, and recovery time. While TLRH offers additional benefits such as faster recovery and fewer complications, its adoption has been limited by longer operative times and technical challenges. AIM To compare the short-term outcomes of TLRH and LARH for the treatment of right -sided colon cancer and explore the advantages and feasibility of TLRH. METHODS Clinical data from 109 right-sided colon cancer patients admitted between January 2019 and May 2021 were retrospectively analyzed. Patients were divided into an observation group (TLRH, n = 50) and a control group (LARH, n = 59). Study variables were operation time, intraoperative bleeding volume, postoperative hospital stays, length of surgical specimen, number of lymph nodes dissected, and postoperative inflammatory factor levels of the two groups of patients. The postoperative complications were analyzed and compared, and survival, recurrence, and remote metastasis rates of the two groups were compared during a 2-year follow-up period. RESULTS The TLRH group showed the advantages of reduced intraoperative bleeding, shorter hospital stays, and quicker recovery. Lymph node dissection outcomes were comparable, and postoperative inflammatory markers were lower in the TLRH group. Complication rates were similar. Short-term follow-up (2 years) revealed no significant differences in recurrence, metastasis, or survival rates. CONCLUSION Compared to LARH, TLRH offers significant advantages in terms of reducing surgical trauma, lowering postoperative inflammatory factor levels, and mitigating the impact on intestinal function. This approach contributes to a shorter hospital stay and promotes postoperative recovery in patients. The study suggests that TLRH may offer favorable outcomes for colorectal cancer patients.
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Affiliation(s)
- Wen-Feng Du
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Tang-Shuai Liang
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Zong-Fei Guo
- College of Clinical and Basic Medicine, Shandong First Medical University, Liaocheng 252000, Shandong Province, China
| | - Jian-Jun Li
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
| | - Cheng-Gang Yang
- Department of Gastrointestinal Surgery, Liaocheng People’s Hospital, Liaocheng 252000, Shandong Province, China
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Liao B, Xue X, Zeng H, Ye W, Xie T, Wang X, Lin S. Comparison of different surgical techniques and anastomosis methods in short-term outcomes of right colon cancer: a network meta-analysis of open surgery, laparoscopic, and robot-assisted techniques with extracorporeal and intracorporeal anastomosis. Updates Surg 2025; 77:309-325. [PMID: 39888546 DOI: 10.1007/s13304-025-02096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 01/07/2025] [Indexed: 02/01/2025]
Abstract
With the rapid development of minimally invasive surgical techniques, there remains considerable controversy regarding the choice of surgical approach and anastomosis method for patients with right-sded colon cancer (RSCC). This meta-analysis compared the short-term outcomes of open right colectomies (ORC), laparoscopic right colectomies with intracorporeal and extracorporeal anastomosis (LRC-IA and LRC-EA), as well as robot right colectomies with intracorporeal and extracorporeal anastomosis (RRC-IA and RRC-EA). A systematic search was conducted across PubMed (n = 549), Web of Science (n = 821), Embase (n = 591), and the Cochrane Central Register (n = 86) from January 2000 to August 2024. Studies comparing at least two of the surgical techniques for RSCC were included. The primary outcomes evaluated were overall complications, wound infection, ileus, and reoperation rates. Secondary outcomes included operative time, blood loss, hospital stay, time to resume diet, and conversion rates. A Bayesian network meta-analysis was performed. A total of 39 studies comprising 6098 patients were included. The results indicated that LRC-IA had the lowest overall complication rate (OR 0.65; 95% CI [0.41, 1.07]), while ORC had the highest. RRC-IA was most effective in reducing wound infection (OR 0.77; 95% CI [0.39, 1.35]), blood loss (MD 18.01; 95% CI [4.62, 40.87]), and hospital stay (MD 0.93; 95% CI [0.67, 1.31]), while also demonstrating advantages in preventing postoperative ileus (OR 0.47; 95% CI [0.05, 1.31]) and ensuring faster bowel function recovery (OR 0.80; 95% CI [0.44, 1.53]). The analysis demonstrates that for patients with RSCC, RRC shows better short-term outcomes compared to LRC and ORC, while IA also surpasses EA.
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Affiliation(s)
- Baobong Liao
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No.105 Jiuyi North Road, Longyan, 364000, Fujian, China
- Fujian Medical University, Fuzhou, China
| | - Xueyi Xue
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No.105 Jiuyi North Road, Longyan, 364000, Fujian, China
- Fujian Medical University, Fuzhou, China
| | - Hao Zeng
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No.105 Jiuyi North Road, Longyan, 364000, Fujian, China
- Fujian Medical University, Fuzhou, China
| | - Wen Ye
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No.105 Jiuyi North Road, Longyan, 364000, Fujian, China
| | - Tingjiang Xie
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No.105 Jiuyi North Road, Longyan, 364000, Fujian, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shuangming Lin
- Department of Gastroenterology and Anorectal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, No.105 Jiuyi North Road, Longyan, 364000, Fujian, China.
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Abdelkhalek M, Shetiwy M, Elbadrawy M, Abdallah A, Altowairqi A, Sedky A. Laparoscopic Versus Open Complete Mesocolic Excision and Central Vascular Ligation in Right-Sided Colon Cancer: A Tertiary Center Experience. Indian J Surg 2024. [DOI: 10.1007/s12262-024-04218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 11/18/2024] [Indexed: 01/04/2025] Open
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De Lange G, Davies J, Toso C, Meurette G, Ris F, Meyer J. Complete mesocolic excision for right hemicolectomy: an updated systematic review and meta-analysis. Tech Coloproctol 2023; 27:979-993. [PMID: 37632643 PMCID: PMC10562294 DOI: 10.1007/s10151-023-02853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/25/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Complete mesocolic excision improves lymphadenectomy for right hemicolectomy and respects the embryological planes. However, its effect on cancer-free and overall survival is questioned. Therefore, we aimed to determine the potential benefits of the technique by performing a systematic review of the literature and meta-analysis of the available evidence. METHODS Web of Science, PubMed/Medline, and Embase were searched on February 22, 2023. Original studies on short- and long-term oncological outcomes of adult patients undergoing right hemicolectomy with complete mesocolic excision as a treatment for primary colon cancer were considered for inclusion. Outcomes were extracted and pooled using a model with random effects. RESULTS A total of 586 publications were identified through database searching, and 18 from citation searching. Exclusion of 552 articles left 24 articles for inclusion. Meta-analysis showed that complete mesocolic excision increased the lymph node harvest (5 studies, 1479 patients, MD 9.62, 95% CI 5.83-13.41, p > 0.0001, I2 84%), 5-year overall survival (5 studies, 2381 patients, OR 1.88, 95% CI 1.14-3.09, p = 0.01, I2 66%), 5-year disease-free survival (4 studies, 1376 patients, OR 2.21, 95% CI 1.51-3.23, p < 0.0001, I2 0%) and decreased the incidence of local recurrence (4 studies, 818 patients, OR 0.27, 95% CI 0.09-0.79, p = 0.02, I2 0%) when compared to standard right hemicolectomy. Perioperative morbidity was similar between the techniques (8 studies, 3899 patients, OR 1.04, 95% CI 0.89-1.22, p = 0.97, I2 0%). CONCLUSION Meta-analysis of observational and randomised studies showed that right hemicolectomy with complete mesocolic excision for primary right colon cancer improves oncologic results without increasing morbidity/mortality. These results need to be confirmed by high-quality evidence and randomised trials in selected patients to assess who may benefit from the procedure.
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Affiliation(s)
- G De Lange
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
| | - J Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - C Toso
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - G Meurette
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - F Ris
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - J Meyer
- Medical School, University of Geneva, Rue Michel-Servet 1, 1206, Geneva, Switzerland.
- Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
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Torky RA, Abdel-Tawab M, Rafaat A, Hefni AM, Abdelmotaleb A. Efficacy and Feasibility of Complete Mesocolic Excision with Central Vascular Ligation in Complicated Colorectal Cancer. Indian J Surg Oncol 2023; 14:312-317. [PMID: 37324302 PMCID: PMC10267057 DOI: 10.1007/s13193-022-01673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
Abstract
Complete mesocolic excision (CME) with central vascular ligation (CVL) involves sharp dissection through the embryological planes. However, it may be associated with high mortalities and morbidities especially in colorectal emergencies. This study aimed to investigate the outcomes of CME with CVL in complicated colorectal cancers (CRCs). This was a retrospective study of emergency CRC resection in a tertiary center between March 2016 and November 2018. A total of 46 patients, with a mean age of 51 years, underwent an emergency colectomy for cancer (males, 26 [56.5%]; females, 20 [43.5%]). CME with CVL was performed for all patients. The mean operative time and blood loss were 188 min and 397 mL, respectively. Only five (10.8%) patients presented with burst abdomen, whereas only three (6.5%) presented with anastomotic leakage. The mean length of vascular tie was 8.7 cm, and the mean number of harvested lymph nodes (LNs) was 21.2. Emergency CME with CVL is a safe and feasible technique when performed by a colorectal surgeon and will result in obtaining a superior specimen with a large number of LNs.
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Affiliation(s)
- Radwan A. Torky
- Department of Surgery, main hospital, Assiut Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Mohamed Abdel-Tawab
- Department of Diagnostic and Interventional Radiology, main hospital, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abadeer Rafaat
- Department of Surgery, main hospital, Assiut Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
| | - Ahmed Mubarak Hefni
- Department of Medical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmed Abdelmotaleb
- Department of Surgery, main hospital, Assiut Faculty of Medicine, Assiut University, Assiut, 71515 Egypt
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Cuk P, Jawhara M, Al-Najami I, Helligsø P, Pedersen AK, Ellebæk MB. Robot-assisted versus laparoscopic short- and long-term outcomes in complete mesocolic excision for right-sided colonic cancer: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:171-181. [PMID: 36001164 DOI: 10.1007/s10151-022-02686-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complete mesocolic excision (CME) surgery is increasingly implemented for the resection of right-sided colonic cancer, possibly resulting in improved 5-year overall and disease-free survival compared to non-CME surgery. However, it is not clear what surgical platform should be used. The aim of this study was to compare the following outcomes between robot-assisted and laparoscopic CME-surgery for right-sided colonic cancer: (i) short-term clinical outcomes, (ii) pathological specimen quality, and (iii) long-term oncological outcomes. METHODS Medline, Embase, and Cochrane Database of Systematic Reviews were searched from inception until August 2021. Pooled proportions were calculated by applying the inverse variance method. Heterogeneity was explored by I-square and supplemented by sensitivity- and meta-regression analyses. The risk of bias was evaluated by either MINORS or Cochrane's risk-of-bias tool (RoB 2). RESULTS Fifty-five studies with 5.357 patients (740 robot-assisted and 4617 laparoscopic) were included in the meta-analysis. Overall postoperative morbidity was 17% [95% CI (14-20%)] in the robot-assisted group and 13% [95%CI (12-13%)] in the laparoscopic group. Robot-assisted CME was associated with a shorter hospital stay, lower intraoperative blood loss, a higher amount of harvested lymph nodes, and better 3-year oerall and disease-free survival. MINORS and RoB2 indicated a serious risk of bias across studies included. CONCLUSIONS This review which includes predominantly non-randomized studies suggests a possible advantage of the robot-assisted CME compared with a laparoscopic technique for several short-term outcomes.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Mohamad Jawhara
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
| | - Issam Al-Najami
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital of Southern Jutland, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
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Sica GS, Vinci D, Siragusa L, Sensi B, Guida AM, Bellato V, García-Granero Á, Pellino G. Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review. Surg Endosc 2023; 37:846-861. [PMID: 36097099 PMCID: PMC9944740 DOI: 10.1007/s00464-022-09548-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several procedures have been proposed to reduce the rates of recurrence in patients with right-sided colon cancer. Different procedures for a radical right colectomy (RRC), including extended D3 lymphadenectomy, complete mesocolic excision and central vascular ligation have been associated with survival benefits by some authors, but results are inconsistent. The aim of this study was to assess the variability in definition and reporting of RRC, which might be responsible for significant differences in outcome evaluation. METHODS PRISMA-compliant systematic literature review to identify the definitions of RRC. Primary aims were to identify surgical steps and different nomenclature for RRC. Secondary aims were description of heterogeneity and overlap among different RRC techniques. RESULTS Ninety-nine articles satisfied inclusion criteria. Eight surgical steps were identified and recorded as specific to RRC: Central arterial ligation was described in 100% of the included studies; preservation of mesocolic integrity in 73% and dissection along the SMV plane in 67%. Other surgical steps were inconstantly reported. Six differently named techniques for RRC have been identified. There were 35 definitions for the 6 techniques and 40% of these were used to identify more than one technique. CONCLUSIONS The only universally adopted surgical step for RRC is central arterial ligation. There is great heterogeneity and consistent overlap among definitions of all RRC techniques. This is likely to jeopardise the interpretation of the outcomes of studies on the topic. Consistent use of definitions and reporting of procedures are needed to obtain reliable conclusions in future trials. PROSPERO CRD42021241650.
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Affiliation(s)
- Giuseppe S Sica
- Minimally Invasive Unit, Department of Surgical Science, University Tor Vergata, Rome, Italy.
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy.
| | - Danilo Vinci
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Leandro Siragusa
- Minimally Invasive Unit, Department of Surgical Science, University Tor Vergata, Rome, Italy
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Bruno Sensi
- Minimally Invasive Unit, Department of Surgical Science, University Tor Vergata, Rome, Italy
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Andrea M Guida
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
| | - Vittoria Bellato
- Department of Surgical Science, Policlinico Tor Vergata - University Tor Vergata, Rome, Italy
- Ospedale IRCCS San Raffaele, Milan, Italy
| | - Álvaro García-Granero
- Colorectal Unit, Hospital Universitario Son Espases, Palma, Spain
- Applied Surgical Anatomy Unit, Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain
- Human Embryology and Anatomy Department, University of Islas Baleares, Palma, Spain
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
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Risk factors of chylous ascites and its relationship with long-term prognosis in laparoscopic D3 lymphadenectomy for right colon cancer. Langenbecks Arch Surg 2022; 407:2453-2462. [PMID: 35589848 DOI: 10.1007/s00423-022-02527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chylous ascites (CA) after laparoscopic D3 lymphadenectomy for right colon cancer is not rare. However, the risk factors for CA have not been fully explored. Few studies have investigated the effect of CA on long-term prognosis. METHODS The clinical data of patients with right colon cancer who underwent laparoscopic D3 lymphadenectomy in five centers from January 2013 to December 2018 were retrospectively collected. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with CA. Then, the long-term prognosis of patients with and without CA was compared by propensity score matching and Kaplan-Meier survival analysis. RESULTS The incidence of CA was 4.4% (48/1090). Pathological T stage (p = 0.025), dissection along the left side of the superior mesenteric artery (p < 0.001) and the number of retrieved lymph nodes (p < 0.001) were independent risk factors for CA. After propensity score matching, 48 patients in the CA group and 353 patients in the non-CA group were enrolled. Kaplan-Meier survival analysis indicated that CA was not associated with overall survival (p = 0.454) and disease-free survival (p = 0.163). In patients with stage III right colon cancer, there were no significant differences in overall survival (p = 0.501) and disease-free survival (p = 0.254). CONCLUSIONS Pathological T stage, number of retrieved lymph nodes, and left side dissection along the superior mesenteric artery were independent risk factors for CA after laparoscopic D3 lymphadenectomy. CA does not impair the oncological outcomes of patients.
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Gojayev A, Mercan Ü, Çetindağ Ö, Akbulut S, Ünal AE, Demirci S. Comparison of Short- and Long-term Outcomes
of Laparoscopic and Open Right Hemicolectomy
for Colon Cancer. POLISH JOURNAL OF SURGERY 2022; 94:45-50. [DOI: 10.5604/01.3001.0015.7344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
<br><b>Introduction:</b> Colorectal cancer is still among the most common malignancies in the world.</br>
<br><b>Aim:</b> The aim of this study is to compare the outcomes of open and laparoscopic right hemicolectomy for colon cancer.</br>
<br><b>Materials and methods:</b> This retrospective study included 87 patients who underwent laparoscopic and open right hemicolectomy for colon cancer between January 2014 and January 2020. Patients were categorized into two groups according to the surgical technique: laparoscopic (46 cases) and open (41 cases). Patient characteristics and clinicopathological findings, surgical findings, short- and long-term results were included in the evaluation parameters. Patients with pathological diagnosis other than adenocarcinoma, distant metastases, and incomplete file datas were excluded from the study.</br>
<br><b>Results:</b> Forty-six (52.9%) patients underwent laparoscopic and 41 (47.1%) patients underwent open right hemicolectomy. The operation time of the laparoscopic group was found to be significantly higher (P<0.001). The amount of blood loss was significantly higher in the open group (P < 0.001). The incidence of post-operative complications in the open group (26.8%) was higher than in the laparoscopic group (6.5%) (P = 0.010). The rate of anastomotic leakage (9.8%) was higher in patients who underwent open surgery compared to laparoscopic group (0%) (P = 0.045). It was found that the laparoscopic group had a shorter hospital stay (P = 0.009). No statistically significant differences were found between the groups in terms of overall overall survival (OS) rate (P = 0.400) and disease-free survival (DFS) rate (P = 0.781).</br>
<br><b>Conclusion:</b> Laparoscopic right hemicolectomy for colon cancer is a feasible and reliable method with lower postoperative morbidity and similar long-term results to the open method.</br>
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Affiliation(s)
- Afig Gojayev
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ümit Mercan
- Department of Surgical Oncology, Sanliurfa Mehmet Akif Inan Traninig and Research Hospital, Sanliurfa, Turkey
| | - Özhan Çetindağ
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Serkan Akbulut
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ali Ekrem Ünal
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Salim Demirci
- Clinic of Surgical Oncology, Department of General Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Cirocchi R, Randolph J, Davies RJ, Cheruiyot I, Gioia S, Henry BM, Carlini L, Donini A, Anania G. A systematic review and meta-analysis of variants of the branches of the superior mesenteric artery: the Achilles heel of right hemicolectomy with complete mesocolic excision? Colorectal Dis 2021; 23:2834-2845. [PMID: 34358401 DOI: 10.1111/codi.15861] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022]
Abstract
AIM Dissection with subsequent ligation and resection of arteries at their origin (central vascular ligation) is essential for adequate oncological resection during right hemicolectomy with complete mesocolic excision. This technique is technically demanding due to the highly variable arterial pattern of the right colon. Therefore, this study aims to provide a comprehensive evidence-based assessment of the arterial vascular anatomy of the right colon. METHODS A thorough systematic literature search through September 2020 was conducted on the electronic databases PubMed, Scopus and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaXl software. RESULTS A total of 41 studies (n = 4691 patients) were included. The ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were present in 99.7% (95% CI 99.4%-99.8%), 72.6% (95% CI 61.3%-82.5%) and 96.9% (95% CI 94.2%-98.8%) respectively of patients. Supernumerary RCA and MCA were observed in 3.2% and 11.4% respectively of all cases. The RCA shared a common trunk with the ICA and MCA in 13.2% and 17.7% respectively of patients. A retro-superior mesenteric vein course of the ICA and RCA was observed in 55.1% and 11.4% respectively of all cases. CONCLUSION The vascular anatomy of the right colon displays several notable variations, namely the absence of some branches (RCA absent in 27.4% of cases), supernumerary branches, common trunks, and retro-superior mesenteric vein courses. These variations should be taken into consideration during right hemicolectomy with complete mesocolic excision to ensure adequate oncological resection while minimizing intra-operative complications.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Sara Gioia
- School of Medicine, Perugia, 3 Section of Legal Medicine, Hospital of Terni, University of Perugia, Terni, Italy
| | | | - Luigi Carlini
- School of Medicine, Perugia, 3 Section of Legal Medicine, Hospital of Terni, University of Perugia, Terni, Italy
| | - Annibale Donini
- Department of Surgical Science, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Gabriele Anania
- Department of Medical Science, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
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Testa DC, Mazzola L, di Martino G, Cotellese R, Selvaggi F. Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study. ANZ J Surg 2021; 92:132-139. [PMID: 34636465 PMCID: PMC9293306 DOI: 10.1111/ans.17264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND To examine the outcome of patients treated with complete mesocolic excision (CME) with central vascular ligation (CVL) after conventional and laparoscopic surgery. METHODS We retrospectively evaluated stage I-IV colon adenocarcinoma patients treated by the same surgeon (L.M.) from 2013 to 2018. Postoperative complications, recurrences and survival are assessed. RESULTS Fifty-one patients (M/F: 24/27) underwent laparoscopic right hemicolectomy with CME (L-CME) or open CME (O-CME) plus CVL. Tumour location was the caecum in 39.2% of cases, the transverse in 23.5%, the hepatic colonic flexure in 21.5%, and the ascending colon in 15.6%. Twenty-four patients underwent L-CME while 27 underwent O-CME. More than 15 harvested lymphnodes are reported in 74.1% of O-CME patients and in 66.7% of L-CME patients (p = 0.562). Postoperative complications occurred in 7 O-CME and 5 L-CME patients, respectively (p = 0.669). Three-year overall survival, including stage IV, was of 75% versus 77.8% for L-CME and O-CME patients, respectively, while for stage I-III, was of 88.9% vs. 80% in L-CME and O-CME, respectively (p = 0.440). The median follow-up was of 2.43 years. CONCLUSION CME with CVL is a meticulous, complex but feasible technique. In our experience, oncological results in terms of recurrences and overall survival, after conventional and laparoscopic CME plus CVL, are comparable. Patients with stage I-III colon adenocarcinoma have a better prognostic trend especially when more than 15 lymphnodes are removed. The respect of oncological radicality and the correct indication to minimally invasive surgery are the undiscussed key outcome variables.
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Affiliation(s)
- Domenica Carmen Testa
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Lorenzo Mazzola
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.,Unit of General Surgery, "Renzetti" Hospital, Lanciano, Italy
| | - Giuseppe di Martino
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Roberto Cotellese
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.,Fondazione Villa Serena per la Ricerca, Pescara, Italy
| | - Federico Selvaggi
- Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.,Unit of General Surgery, "Renzetti" Hospital, Lanciano, Italy
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Koc MA, Celik SU, Guner V, Akyol C. Laparoscopic vs open complete mesocolic excision with central vascular ligation for right-sided colon cancer. Medicine (Baltimore) 2021; 100:e24613. [PMID: 33578570 PMCID: PMC7886421 DOI: 10.1097/md.0000000000024613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
Complete mesocolic excision (CME) is being performed more frequently and has recently become an established oncologic surgical method for right hemicolectomy. Despite its advantages, such as its association with early mobilization, a short hospital stay, early bowel movement, mild postoperative pain, and good cosmesis, CME is technically demanding and carries the risk of severe complications. This study aims to compare the clinical, pathological, and oncological results of open and laparoscopic right hemicolectomy with CME.The data of 76 patients who underwent right hemicolectomy with CME and high vascular ligation were reviewed retrospectively. The patients were divided into 2 groups according to whether the open or laparoscopic technique was used.Thirty-two patients underwent open right hemicolectomy, and 44 patients underwent laparoscopic right hemicolectomy. The 2 groups were similar in age, sex, American Society of Anesthesiologists class, abdominal surgical history, tumor localization, and operation time. No significant differences were found regarding the specimen length, tumor size, harvested lymph nodes, number of metastatic lymph nodes, or tumor grade. According to the Clavien-Dindo classification system, the laparoscopic group had significantly fewer complications than did the open group (11.4% vs 31.2%; P = .04). The open group had a longer postoperative hospital stay than did the laparoscopic hemicolectomy group (9.9 ± 4.7 vs 7.2 ± 3.1 days; P = .002). In addition, the groups were similar with respect to disease-free survival (P = .14) and overall survival (P = .06).The data in this study demonstrated that no differences exist between the open and laparoscopic techniques concerning pathological and oncological results. However, significantly fewer complications and a shorter length of hospital stay were observed in the laparoscopic group than in the open group. Laparoscopic right hemicolectomy with CME and central vascular ligation is a safe and feasible surgical procedure and should be considered the standard technique for right-sided colon cancer.
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Affiliation(s)
- Mehmet Ali Koc
- Department of General Surgery, Ankara University School of Medicine
| | - Suleyman Utku Celik
- Department of General Surgery, Ankara University School of Medicine
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Volkan Guner
- Department of General Surgery, Ankara University School of Medicine
| | - Cihangir Akyol
- Department of General Surgery, Ankara University School of Medicine
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13
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Laparoscopic versus Open Complete Mesocolic Excision for Right Colon Cancer. Int J Surg Oncol 2021; 2021:8859879. [PMID: 33604087 PMCID: PMC7872753 DOI: 10.1155/2021/8859879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 01/04/2023] Open
Abstract
Results The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P=0.010). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) (P=0.252). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance (P value = 0.266). Conclusions In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.
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14
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Metastasis to lymph nodes around the vascular tie worsens long-term oncological outcomes following complete mesocolic excision and conventional colectomy for right-sided colon cancer. Tech Coloproctol 2021; 25:309-317. [PMID: 33398660 DOI: 10.1007/s10151-020-02378-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oncologic outcomes after complete mesocolic excision (CME) in colon cancer are under investigation. The aim of our study was to compare CME and conventional colectomy (CC) in terms of pathological and oncological outcomes for right colon cancer and to evaluate the impact of lymph node metastasis around the vascular tie on survival. METHODS Consecutive patients with right colon cancer who had CME or CC between January 2011 and August 2018 at two specialized centers in Turkey were included. Statistical analyses were performed with respect to demographic characteristics, operative and pathologic outcomes, harvested and metastatic lymph nodes around the vascular tie (LNVT), recurrences, and survival. RESULTS There were 91 patients in the CME group (58 males, mean age 64 ± 16 years) and 192 patients in the CC group (96 males, mean age 66 ± 14 years). The mean number of harvested lymph nodes (CME: 42 ± 15 vs CC: 34 ± 13, p = 0.01) and LNVT were higher in the CME group (CME: 3.2 ± 2.2 vs CC: 2.4 ± 1.6, p = 0.001). LNVT metastases were 7.7% and 8.3% in the CME and CC groups, respectively (p = 0.85). Three-year overall and disease-free survival rates were 96.4% and 90.9% in the CME group and 90.4% and 87.6% in the CC group in stage I-III patients (p > 0.05). In stage III patients, the 3-year overall survival (92.5% vs 63.5%, p = 0.03) and disease-free survival (85.6% vs 52.1%, p = 0.008) were significantly better in LNVT-negative patients than in LNVT-positive patients. CONCLUSION LNVT metastasis seems to be the key factor associated with poor disease-free and overall survival in right colon cancer regardless of the radicality of surgery.
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Anania G, Arezzo A, Davies RJ, Marchetti F, Zhang S, Di Saverio S, Cirocchi R, Donini A. A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision. Int J Colorectal Dis 2021; 36:1609-1620. [PMID: 33644837 PMCID: PMC8280018 DOI: 10.1007/s00384-021-03891-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery. METHODS PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios. RESULTS Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, - 0.41-1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI - 0.20-6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD - 0.55, 95% CI - 0.57-1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups. CONCLUSIONS Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.
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Affiliation(s)
- Gabriele Anania
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Alberto Arezzo
- grid.7605.40000 0001 2336 6580Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Richard Justin Davies
- grid.24029.3d0000 0004 0383 8386Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francesco Marchetti
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
| | - Shu Zhang
- grid.452404.30000 0004 1808 0942Department of Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Salomone Di Saverio
- grid.18147.3b0000000121724807Department of General Surgery, University of Insubria, Varese, Italy
| | - Roberto Cirocchi
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
| | - Annibale Donini
- grid.9027.c0000 0004 1757 3630Department of General Surgery, University of Perugia, Perugia, PG Italy
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Chen Y, Bian L, Zhou H, Wu D, Xu J, Gu C, Fan X, Liu Z, Zou J, Xia J, Xu Z. Usefulness of three-dimensional printing of superior mesenteric vessels in right hemicolon cancer surgery. Sci Rep 2020; 10:11660. [PMID: 32669641 PMCID: PMC7363793 DOI: 10.1038/s41598-020-68578-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/17/2020] [Indexed: 11/30/2022] Open
Abstract
The anatomy of the superior mesenteric vessels is complex, yet important, for right-sided colorectal surgery. The usefulness of three-dimensional (3D) printing of these vessels in right hemicolon cancer surgery has rarely been reported. In this prospective clinical study, 61 patients who received laparoscopic surgery for right hemicolon cancer were preoperatively randomized into 3 groups: 3D-printing (20 patients), 3D-image (19 patients), and control (22 patients) groups. Surgery duration, bleeding volume, and number of lymph node dissections were designed to be the primary end points, whereas postoperative complications, post-operative flatus recovery time, duration of hospitalization, patient satisfaction, and medical expenses were designed to be secondary end points. To reduce the influence of including different surgeons in the study, the surgical team was divided into 2 groups based on surgical experience. The duration of surgery for the 3D-printing and 3D-image groups was significantly reduced (138.4 ± 19.5 and 154.7 ± 25.9 min vs. 177.6 ± 24.4 min, P = 0.000 and P = 0.006), while the number of lymph node dissections for the these 2 groups was significantly increased (19.1 ± 3.8 and 17.6 ± 3.9 vs. 15.8 ± 3.0, P = 0.001 and P = 0.024) compared to the control group. Meanwhile, the bleeding volume for the 3D-printing group was significantly reduced compared to the control group (75.8 ± 30.4 mL vs. 120.9 ± 39.1 mL, P = 0.000). Moreover, patients in the 3D-printing group reported increased satisfaction in terms of effective communication compared to those in the 3D-image and control groups. Medical expenses decreased by 6.74% after the use of 3D-printing technology. Our results show that 3D-printing technology could reduce the duration of surgery and total bleeding volume and increase the number of lymph node dissections. 3D-printing technology may be more helpful for novice surgeons. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800017161. Registered on 15 July 2018.
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Affiliation(s)
- Yigang Chen
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, 68 Zhongshan Road, Wuxi, 214002, Jiangsu, People's Republic of China
| | - Linjie Bian
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, 214002, People's Republic of China
| | - Hong Zhou
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, 68 Zhongshan Road, Wuxi, 214002, Jiangsu, People's Republic of China
| | - Danping Wu
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, 214002, People's Republic of China
| | - Jie Xu
- Operating Room, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, 214002, People's Republic of China
| | - Chen Gu
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, 68 Zhongshan Road, Wuxi, 214002, Jiangsu, People's Republic of China
| | - Xinqi Fan
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, 68 Zhongshan Road, Wuxi, 214002, Jiangsu, People's Republic of China
| | - Zhequn Liu
- Harbin JunYang Technology Co., Ltd, Harbin, 150000, People's Republic of China
| | - Junyi Zou
- Operating Room, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, 214002, People's Republic of China
| | - Jiazeng Xia
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, 68 Zhongshan Road, Wuxi, 214002, Jiangsu, People's Republic of China.
| | - Zekuan Xu
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, 140 Hanzhong Road, Nanjing, 210029, People's Republic of China.
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Laparoscopic Versus Open Complete Mesocolon Excision in Right Colon Cancer: A Systematic Review and Meta-Analysis. World J Surg 2020; 43:3179-3190. [PMID: 31440778 DOI: 10.1007/s00268-019-05134-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic complete mesocolon excision (LCME) for right colonic cancer improves oncological outcomes. This systematic review and meta-analysis aimed to compare intraoperative, postoperative, and oncological outcomes after LCME and open total mesocolon excision (OCME) for right-sided colonic cancers. METHODS Literature searches of electronic databases and manual searches up to January 31, 2019, were performed. Random-effects meta-analysis model was used. Review Manager Version 5.3 was used for pooled estimates. RESULTS After screening 1334 articles, 10 articles with a total of 2778 patients were eligible for inclusion. Compared to OCME, LCME improves results in terms of overall morbidity (OR = 1.48, 95% CI 1.21 to 1.80, p = 0.0001), blood loss (MD = 56.56, 95% CI 19.05 to 94.06, p = 0.003), hospital stay (MD = 2.18 day, 95% CI 0.54 to 3.83, p = 0.009), and local (OR = 2.12, 95% CI 1.09 to 4.12, p = 0.03) and distant recurrence (OR = 1.63, 95% CI 1.23-2.16, p = 0.0008). There was no significant difference regarding mortality, anastomosis leakage, number of harvested lymph nodes, and 3-year disease-free survival. Open approach was significantly better than laparoscopy in terms of operative time (MD = - 34.76 min, 95% CI - 46.01 to - 23.50, p < 0.00001) and chyle leakage (OR = 0.41, 95% CI 0.18 to 0.96, p = 0.04). CONCLUSIONS This meta-analysis suggests that LCME in right colon cancer surgery is superior to OCME in terms of overall morbidity, blood loss, hospital stay, and local and distant recurrence with a moderate grade of recommendation due to the retrospective nature of the included studies.
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Gavriilidis P, Davies RJ, Biondi A, Wheeler J, Testini M, Carcano G, Di Saverio S. Laparoscopic versus open complete mesocolic excision: a systematic review by updated meta-analysis. Updates Surg 2020; 72:639-648. [PMID: 32472404 DOI: 10.1007/s13304-020-00819-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023]
Abstract
Recent evidence has proven the non-inferiority of laparoscopic complete mesocolic excision (LCME) to open complete mesocolic excision (OCME) with regard to feasibility and oncological safety. However, the differences in survival benefits between the 2 procedures have not been assessed. The aim of this study was to evaluate whether or not one procedure was superior to the other using updated meta-analysis. A systematic search for relevant literature was performed in Pubmed, Embase, Cochrane library and Google scholar databases. This meta-analysis included retrospective studies and one randomised controlled trial comparing LCME to OSCME. LCME to OCME was evaluated using updated meta-analysis. The Newcastle-Ottawa scale was used to assess the methodologic quality of the studies. Fixed- and random-effects models were used, and survival outcomes were assessed using the inverse variance hazard ratio (HR) method. Operative time was significantly shorter in the OCME cohort than in the LCME cohort. Blood loss, wound infections, time to flatus, time to oral feeding, and length of hospital stay were significantly shorter in the LCME cohort than in the OCME cohort. The 1-, 3-, and 5-year overall survivals were better in the LCME cohort than in the OCME cohort ([HR = 0.37 (0.22, 0.65); p = 0.004], [HR = 0.48 (0.31, 0.74); p = 0.008], and [HR = 0.64 (0.45, 0.93); p = 0.02], respectively). No difference in the 1-year disease-free survival (DFS) between the 2 procedures was observed ([HR = 0.68 (0.44, 1.03); p = 0.07]). In contrast, the LCME cohort had better 3- and 5-year DFS rates than those of the OCME cohort ([HR = 0.63 (0.42, 0.97), p = 0.03] and [HR = 0.68 (0.56, 0.83), p = 0.001], respectively). The results of the present study must be interpreted cautiously because the included studies were retrospective from single centres. Therefore, selection, institutional and national bias may have influenced the results. LCME is associated with the faster postoperative recovery and some better potential survival benefits than OCME.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of General and Colorectal Surgery, York Teaching Hospitals, NHS Foundation Trust, Scarborough, YO12 6QL, UK
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Antonio Biondi
- Department of Surgery, University of Catania, Catania, Italy
| | - James Wheeler
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Mario Testini
- Department of Surgery, University of Bari, Bari, Italy
| | - Giulio Carcano
- Department of Surgery, University of Insubria, Insubria, Italy
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Abstract
INTRODUCTION Complete mesocolic excision for colonic cancer is similar in concept to total mesorectal excision for rectal cancer. This review aims to provide the embryological and anatomical rationale behind CME, and to review the current literature on CME, relative to the feasibility via laparoscopy, the oncological adequacy and outcomes. EVIDENCE ACQUISITION A literature search was performed at the end of 2017 according the PRISMA guidelines for systematic reviews. Of 3980 articles found, we analyzed 96 articles. Of note, many case series had overlapping populations; there were five review articles, two consensus conference proceedings, six comparative but only one randomized trial. EVIDENCE SYNTHESIS The embryonic and anatomical rationale is well described. CME is feasible via laparoscopy, which may facilitate dissection and anatomic precision: no statistically significant differences were found when compared to open CME regarding overall survival. However, morbidity may be higher in the hands of non-expert laparoscopic surgeons. CONCLUSIONS Oncological adequacy can be obtained with laparoscopic CME, with increased lymph node retrieval. However, until now, there is no formal proof that CME improves local recurrence or survival.
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Affiliation(s)
- Abe Fingerhut
- Section for Surgical Research, Department of Surgery, University of Graz, Graz, Austria -
| | | | - Luigi Boni
- Department of Surgery IRCCS, Ca' Granda Policlinico Hospital, University of Milan, Milan, Italy
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, University of Graz, Graz, Austria
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Yozgatli TK, Aytac E, Ozben V, Bayram O, Gurbuz B, Baca B, Balik E, Hamzaoglu I, Karahasanoglu T, Bugra D. Robotic Complete Mesocolic Excision Versus Conventional Laparoscopic Hemicolectomy for Right-Sided Colon Cancer. J Laparoendosc Adv Surg Tech A 2019; 29:671-676. [PMID: 30807257 DOI: 10.1089/lap.2018.0348] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Robotic technique has been proposed to overcome the limitations of laparoscopic surgery. In this study, we aimed at determining whether robotic complete mesocolic excision (CME) for right-sided colon cancer can be safe and effective as conventional laparoscopic right hemicolectomy (CLRH). Materials and Methods: Between February 2015 and September 2017, patients undergoing robotic right CME and CLRH with curative intent for right-sided colon cancer were included. Patient characteristics, short-term and histopathological outcomes were compared between the groups. Results: Ninety-six patients (robotic, n = 35) were included in this study. The operative time (286 ± 77 versus 132 ± 40 minutes, P = .0001) was significantly longer in the robotic group. There were no conversions in either group. No significant differences existed between the groups regarding the mean estimated blood loss, time to first flatus, length of hospital stay (6 ± 3 versus 6 ± 3 days, P = .64), and follow-up times (robotic 15 ± 8 versus laparoscopic 16 ± 10 months P = .11). Overall complication rates (n = 10 [29%] versus n = 15 [25%], P = .67) were similar. In the robotic group, vascular injury occurred in 2 patients, and both were repaired robotically. The mean number of harvested lymph nodes was significantly higher (41 ± 12 versus 33 ± 10, P = .04) and length between the vascular tie and colonic wall was longer (13 ± 3.5 versus 11 ± 3, P = .02) in the robotic group. Conclusion: Although robotic right CME seems equally safe to CLRH in terms of short-term morbidity, future prospective randomized trials are needed to define its role for treatment of right colectomy.
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Affiliation(s)
- Tahir K Yozgatli
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Erman Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Volkan Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Onur Bayram
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Gurbuz
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koc University School of Medicine, Istanbul, Turkey
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Laparoscopic Complete Mesocolic Excision for Right-Sided Colon Cancer: Analysis of Feasibility and Safety from a Single Western Center. J Gastrointest Surg 2019; 23:402-407. [PMID: 30430433 DOI: 10.1007/s11605-018-4040-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/29/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Colectomies performed according to complete mesocolic excision (CME) principles have demonstrated an improvement in the quality of surgical specimen and a potential improvement of long-term results. Laparoscopic CME right hemicolectomy is considered a demanding procedure and adopted in few centers from the West. The main purpose of this paper is to present a video showing our technique for laparoscopic CME right hemicolectomy and to analyze our short-term results to prove its safety. METHODS Data from 38 patients operated on at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, between September 2014 and February 2017, were included in the study. RESULTS In the present series, 37% of patients were ≥75 years old, 32% of patients were ASA class 3, 46% of patients had ≥2 comorbidities, 30% of patients had BMI >28 and 17% of patients had ≥2 previous abdominal surgeries. Despite these unfavorable clinic characteristics, no mortality was observed, Clavien-Dindo ≥3 complications occurred in 13.1% and redo surgery in 5.3%. Good quality specimens were obtained with a mean (SD) length of 34.5±7.5 cm, a proximal margin of 16.8±9.2 cm and a distal margin of 14.3±6.4 cm. The mean (SD) number of harvested lymph nodes was 24.3 (8.3). CONCLUSIONS When implemented in a Western center, laparoscopic CME right hemicolectomy is feasible and safe and allows obtaining good quality specimens.
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Abstract
Robotic surgery is safe and feasible offering many potential advantages to the colorectal surgeon.
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Affiliation(s)
| | - D G Jayne
- St James's University Hospital, Leeds
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Ozben V, Aytac E, Atasoy D, Erenler Bayraktar I, Bayraktar O, Sapci I, Baca B, Karahasanoglu T, Hamzaoglu I. Totally robotic complete mesocolic excision for right-sided colon cancer. J Robot Surg 2018; 13:107-114. [PMID: 29774501 DOI: 10.1007/s11701-018-0817-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022]
Abstract
Complexity and operative risks of complete mesocolic excision (CME) seem to be important drawbacks to generalize this procedure in the surgical treatment of right colon cancer. Robotic systems have been developed to improve quality and outcomes of minimal invasive surgery. The aim of this study was to evaluate the feasibility of robotic right-sided CME and present our initial experience. A retrospective review of 37 patients undergoing totally robotic right-sided CME between February 2015 and November 2017 was performed. All the operations were carried out using the key principles of both CME with intracorporeal anastomosis and no-touch technique. Data on perioperative clinical findings and short-term outcomes were analyzed. There were 20 men and 17 women with a mean age of 64.4 ± 13.5 years and a body mass index of 26.8 ± 5.7 kg/m2. The mean operative time and estimated blood loss were 289.8 ± 85.3 min and 77.4 ± 70.5 ml, respectively. Conversion to laparoscopy occurred in one patient (2.7%). All the surgical margins were clear and the mesocolic plane surgery was achieved in 27 (72.9%) of the cases. The mean number of harvested lymph nodes was 41.8 ± 11.9 (median, 40; range 22-65). The mean length of hospital stay was 6.6 ± 3.7 days. The intraoperative and postoperative complication rates were 5.4 and 21.6%, respectively. We believe that use of robot for right-sided CME is feasible and appears to provide remarkably a high number of harvested lymph nodes with good specimen quality.
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Affiliation(s)
- Volkan Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Erman Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Deniz Atasoy
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ilknur Erenler Bayraktar
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Onur Bayraktar
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ipek Sapci
- School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
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Croner RS, Ptok H, Merkel S, Hohenberger W. Implementing complete mesocolic excision for colon cancer - mission completed? Innov Surg Sci 2018; 3:17-29. [PMID: 31579762 PMCID: PMC6754049 DOI: 10.1515/iss-2017-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023] Open
Abstract
The definition of complete mesocolic excision (CME) for colon carcinomas revolutionized the way of colon surgery. This technique conquered the world starting from Erlangen. Nevertheless, currently new developments especially in minimally invasive surgery challenge CME to become settled as a standard of care. To understand the evolution of CME, anatomical details occurring during embryogenesis and their variations have to be considered. This knowledge is indispensable to transfer CME from an open to a minimally invasive setting. Conventional surgery for colon cancer (non-CME) has a morbidity of 12.1–28.5% and a 3.7% mortality risk vs. 12–36.4% morbidity and 2.1–3% mortality for open CME. The morbidity of laparoscopic CME is between 4 and 31% with a mortality of 0.5–0.9%. In robotic assisted surgery, morbidity between 10 and 25% with a mortality of 1% was published. The cancer-related survival after 3 and 5 years for open CME is respectively 91.3–95% and 90% vs. 87% and 74% for non-CME. For laparoscopic CME the 3- and 5-year cancer-related survival is 87.8–97% and 79.5–80.2%. In stage UICC III the 3- and 5-year cancer-related survival is 83.9% and 80.8% in the Erlangen data of open technique vs. 75.4% and 65.5–71.7% for laparoscopic surgery. For stage UICC III the 3- and 5-year local tumor recurrence is 3.8%. The published data and the results from Erlangen demonstrate that CME is safe in experienced hands with no increased morbidity. It offers an obvious survival benefit for the patients which can be achieved solely by surgery. Teaching programs are needed for minimally invasive CME to facilitate this technique in the same quality compared to open surgery. Passing these challenges CME will become the standard of care for patients with colon carcinomas offering all benefits of minimally invasive surgery and oncological outcome.
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Affiliation(s)
- Roland S. Croner
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Henry Ptok
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Susanne Merkel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
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Reichert B, Aselmann H, Schafmayer C, Becker T. Laparoskopische komplette mesokolische Exzision. COLOPROCTOLOGY 2018; 40:24-30. [DOI: 10.1007/s00053-017-0220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Negoi I, Hostiuc S, Negoi RI, Beuran M. Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis. World J Gastrointest Oncol 2017; 9:475-491. [PMID: 29290918 PMCID: PMC5740088 DOI: 10.4251/wjgo.v9.i12.475] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/08/2017] [Accepted: 09/04/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the effectiveness of laparoscopic complete mesocolic excision (CME) with central vascular ligation (L-CME) with its open (O-CME) counterpart. METHODS We conducted an electronic search of the PubMed/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, SciELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen (lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individual studies. RESULTS A total of one RCT and eleven CCTs (four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes (MD = -1.06, 95%CI: -3.65 to 1.53, P = 0.42), and tumor to high tie distance (MD = 14.26 cm, 95%CI: -4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group (MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions (OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall (OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I2 = 28%) and disease-free (OR = 1.45, 95% CI: 1.00 to 2.10, P = 0.05, I2 = 0%) survival. CONCLUSION The laparoscopic approach offers the same quality of the resected specimen as the open approach in complete mesocolic excision with central vascular ligation for colon cancer. The laparoscopic complete mesocolic excision with central vascular ligation is superior in all perioperative results and at least non-inferior in long-term oncological outcomes.
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Affiliation(s)
- Ionut Negoi
- Department of General Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Sorin Hostiuc
- National Institute of Legal Medicine Mina Minovici, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Ruxandra Irina Negoi
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
| | - Mircea Beuran
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
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27
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Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW, Park YA, Chun HK. Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc 2017; 32:2721-2731. [PMID: 29101572 PMCID: PMC5956070 DOI: 10.1007/s00464-017-5970-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023]
Abstract
Background The introduction of complete mesocolic excision (CME) with central vessel ligation (CVL) for right-sided colon cancer has improved oncologic outcomes. However, there is controversy over the oncologic safety of laparoscopic CME with CVL. This study compared short-term and long-term oncologic outcomes between laparoscopic and open modified CME (mCME) with CVL in patients with right-sided colon cancer. Methods We enrolled 1239 patients who underwent open mCME with CVL and 1010 patients treated by a laparoscopic approach for right-side colon cancer between 2000 and 2013 and used 1:1 propensity score matching to adjust for potential baseline confounders between two groups. Results After propensity score matching, 683 patients who underwent open mCME with CVL were compared with 683 patients treated with a laparoscopic approach. There were no significant differences between these groups in age, sex, ASA score, TNM stage, tumor size, lymphovascular invasion, and perineural invasion. Comparison of open and laparoscopic mCME groups showed no significant difference in postoperative morbidity (21.4 vs. 18.3%, p = 0.175) and mortality (0.1 vs. 0%, p = 1.000). The laparoscopic mCME group showed shorter length of hospital stay. The 5-year overall survival rate was 83.7% in the open group and 94.7% in the laparoscopic group (p < 0.001). The laparoscopic group also showed a significantly better 5-year disease-free survival rate (82.7 vs. 88.7%, p = 0.009) and 5-year disease-specific survival rate (83.7 vs. 94.7%, p < 0.001). Conclusion Laparoscopic modified mesocolic excision with central vascular ligation is a safe and feasible approach with better short-term recovery profiles and potential oncologic benefits than the open approach for right-sided colon cancer.
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Affiliation(s)
- Jung Kyong Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract
The use of laparoscopy has become widespread across many surgical specialties. Its utility as treatment for colon cancer was initially met with hesitancy due to concern for port site and wound recurrences; however, this was later disproven by large retrospective series. Subsequently, there have been multiple, large, prospective, randomized studies evaluating laparoscopic versus open colectomy for colon cancer. All studies yielded similar results and showed no statistical difference in overall survival, disease-free survival, and recurrence. Additionally, these studies revealed similar operative outcomes with respect to complication rates, perioperative mortality, and conversion to open colectomy, as well as equivalent oncologic resections. Overall in the laparoscopic colectomy groups, hospital stays were shorter, and often times patients required less narcotics postoperatively, but laparoscopic operative times were longer. With adequate training, the use of laparoscopy can be safely employed for patients with colon cancer.
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Affiliation(s)
- Brenton R Franklin
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Michael P McNally
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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Kim NK, Kim YW, Han YD, Cho MS, Hur H, Min BS, Lee KY. Complete mesocolic excision and central vascular ligation for colon cancer: Principle, anatomy, surgical technique, and outcomes. Surg Oncol 2016; 25:252-62. [PMID: 27566031 DOI: 10.1016/j.suronc.2016.05.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/19/2016] [Indexed: 12/15/2022]
Abstract
Classic colon cancer surgery refers to a wide resection of the tumor-bearing segment and the lymphatics draining along the named artery. The concept of TME has been applied to colon cancer and complete mesocolic excision (CME) in conjuction with central vascular ligation (CVL) has been introduced as the surgical treatment for colon cancer. Here, we discuss appropriate CME procedure with regard to the oncologic backgrounds, essential components, applied anatomy, laparoscopic technique, short-term, and oncologic outcomes. The introduction of CME has improved oncologic outcomes greatly in patients with colon cancer. The improved outcomes with CME can be attributed to underlying sound oncologic principles such as dissection through the proper plane of mesocolic excision, central vascular ligation, and sufficient length of proximal and distal margins. Thereby, CME technique can achieve en bloc removal of the diseased lesion with the increased amount of the colonic mesentery even though the length of for both bowel and mesentery resection remains a matter of debate. CME is a technically demanding operation thus, comprehensive understanding of the applied vascular anatomy is essential for successful CME. Favorable outcomes of open CME have been replicated with a laparoscopic approach. In future perspective, incorporating a structured education program on minimally invasive (laparoscopy or robot) CME would be beneficial.
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Affiliation(s)
- Nam Kyu Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea.
| | - Young Wan Kim
- Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Yoon Dae Han
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Soo Cho
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk Hur
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Young Lee
- Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea
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Formisano G, Misitano P, Giuliani G, Calamati G, Salvischiani L, Bianchi PP. Laparoscopic versus robotic right colectomy: technique and outcomes. Updates Surg 2016; 68:63-9. [PMID: 26992927 DOI: 10.1007/s13304-016-0353-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/20/2016] [Indexed: 12/22/2022]
Abstract
Minimally invasive surgery has gained worldwide acceptance in the treatment of colonic cancer in the last decades, thanks to its well-known advantages in short-term outcomes. Nevertheless, the penetrance of minimally invasive colorectal surgery still remains low. Few studies and metanalysis, to date, have analyzed the results of robotic versus laparoscopic colorectal surgery, often with conflicting conclusions. The robotic platform, thanks to its technological features, may potentially overcome the limitation of standard laparoscopy, especially when performing a complete mesocolic excision resection and an intracorporeal anastomosis. Robotic surgery could also shorten the learning curve of young novice surgeons, provided that strict protocols of structured training are applied. This paper is an update on the current available outcomes of robotic vs laparoscopic surgery in right colectomy.
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Affiliation(s)
- Giampaolo Formisano
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy.
| | - Pasquale Misitano
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Giuseppe Giuliani
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Giulia Calamati
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Lucia Salvischiani
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paolo Pietro Bianchi
- Department of General and Minimally-invasive Surgery, International School of Robotic Surgery, Misericordia Hospital, Grosseto, Italy
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Ozben V, Baca B, Atasoy D, Bayraktar O, Aghayeva A, Cengiz TB, Erguner I, Karahasanoglu T, Hamzaoglu I. Robotic complete mesocolic excision for right-sided colon cancer. Surg Endosc 2016; 30:4624-5. [PMID: 26902612 DOI: 10.1007/s00464-016-4786-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
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Kim IY, Kim BR, Choi EH, Kim YW. Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation. Int J Surg 2016; 27:151-157. [PMID: 26850326 DOI: 10.1016/j.ijsu.2016.02.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the pathologic, short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision (CME) and central ligation for right-sided colon cancer. METHODS All patients (n = 215) underwent elective CME either by open surgery (n = 99) or laparoscopy (n = 116). RESULTS Mean number of retrieved lymph nodes (31 vs. 27, p = 0.012) was greater in the open CME group. Between the open and laparoscopic CME groups, there were no differences of length of the specimen (44.3 cm and 43.2 cm), ileum (14 cm and 13.3 cm), or colon (30.3 cm and 29.8 cm), respectively. Proximal and distal margins were similar. Mean operative time was similar between the open and laparoscopic CME groups (175 min vs. 178 min). The rate of 30-day postoperative complications (36.4% vs. 23.3%, p = 0.036) was higher in the open CME group. There were no differences in 3-year overall survival rates (86.9% vs. 95.5% in stage II disease and 70.2% vs. 90.7% in stage III disease) or recurrence-free survival rates (84.5% vs. 84.8% in stage II disease and 64.2% vs. 68.9% in stage III disease) between the open and laparoscopic CME groups. CONCLUSIONS Pathologic (specimen lengths, resection margin lengths, number of lymph nodes, and R0 resection) and oncologic outcomes of the laparoscopic CME group were comparable. Moreover, laparoscopic CME conferred short-term benefits in terms of lower rates of postoperative complications, reduced time to soft diet, and reduced length of hospital stay. Based on these results, laparoscopic CME can be considered as a routine elective approach for right-sided colon cancer.
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Affiliation(s)
- Ik Yong Kim
- Department of Surgery, Division of Gastrointestinal Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Bo Ra Kim
- Department of Internal Medicine, Division of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Eun Hee Choi
- Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Young Wan Kim
- Department of Surgery, Division of Gastrointestinal Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea.
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