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Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Complete mesocolic excision (CME) with central vascular ligation (CVL) has been proposed for treatment of colon cancers based on the same principles as total mesorectal excision. Impressive outcomes have been reported, however, direct comparisons with the classic procedure are lacking.

Methods

Forty-five consecutive patients operated on in the last 5 years with CME and CVL right hemicolectomy entered the study. Fifty-eight right-sided colon cancer patients operated in the previous 5 years with classic approach constituted the control group. Intra- and postoperative course assessed the safety of the procedure. Primary end-points for oncological adequacy were recurrence and survival rate.

Results

All operations were successful with no increase in postoperative complications (p = 0.85). Number of harvested nodes and length of vascular ligation were shown to be significantly better in the CME group (p < 0.01). A higher number of tumor deposits were harvested thus allowing chemotherapy in newly upstaged patients. Locoregional recurrences were never experienced in CME patients (p = 0.03). The risk of cancer-related death was reduced by over one half in all CME patients, and even by three quarters in node-positive tumors. The classic operation was significantly associated with poor outcome (p < 0.01).

Conclusion

This study shows that CME with CVL is a safe and effective surgical approach for right colon cancer, thus confirming the previously reported oncological adequacy. The procedure was shown to significantly decrease local recurrences and to improve the survival rate, particularly in node-positive patients. Urgent diffusion of this technique is warranted.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, School of Medicine, Second University of Naples, c/o II Policlinico, Edificio 17 Via Pansini, 5, 80131, Naples, Italy

    Gennaro Galizia, Eva Lieto, Anna Zamboli, Andrea Mabilia, Annamaria Auricchio, Paolo Castellano & Vincenzo Napolitano

  2. Division of Medical Oncology, F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, School of Medicine, Second University of Naples, Naples, Italy

    Ferdinando De Vita & Michele Orditura

  3. Unit of Pathology, F. Magrassi–A. Lanzara” Department of Clinical and Experimental Medicine and Surgery, School of Medicine, Second University of Naples, Naples, Italy

    Francesca Ferraraccio

Authors
  1. Gennaro Galizia
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  2. Eva Lieto
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  3. Ferdinando De Vita
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  4. Francesca Ferraraccio
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  5. Anna Zamboli
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  6. Andrea Mabilia
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  7. Annamaria Auricchio
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  8. Paolo Castellano
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  9. Vincenzo Napolitano
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  10. Michele Orditura
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Corresponding author

Correspondence to Gennaro Galizia.

Additional information

Gennaro Galizia and Eva Lieto contributed equally to this work.

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Galizia, G., Lieto, E., De Vita, F. et al. Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study. Int J Colorectal Dis 29, 89–97 (2014). https://doi.org/10.1007/s00384-013-1766-x

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