Surgery along the embryological planes for colon cancer: a systematic review of complete mesocolic excision
- 1.6k Downloads
Complete mesocolic excision (CME) for colonic cancer offers a surgical specimen of higher quality, with higher number of lymph nodes compared to conventional colectomy. However, evidence on oncological outcomes is limited. The aim of the present study is to review recent literature and provide more information regarding the effect of CME colectomy on short- and long-term outcomes.
PubMed and MEDLINE databases were searched, and articles in English reporting data on CME were reviewed. Intraoperative events; postoperative morbidity and mortality; histopathological characteristics, including macroscopic assessment, number, and status of retrieved lymph nodes; and oncological outcomes were the end-points.
Thirty-two studies were analyzed. As regards the macroscopic assessment, a larger specimen (p = 0.02) that contains a higher number of lymph nodes (p < 0.00001) is acquired after CME. Two studies report a higher disease-free survival, in stage I and II and particularly in stage III disease after CME. CME by laparoscopy offers comparable outcomes, as regards intraoperative blood loss and immediate postoperative morbidity and mortality rates. Specimen quality is similar after either approach, for cancers located at the right and left colon, but not at the transverse colon.
There is strong evidence that CME offers a longer central pedicle that contains more lymph nodes than conventional surgery for colon cancer. CME represents the surgical background for the maximum lymph node harvest, an important quality marker for the surgical outcome. However, and according to present data, there is limited evidence that colectomy in terms of CME leads to improved long-term oncological outcomes.
KeywordsComplete mesocolic excision Central vascular ligation Colon cancer Systematic review Meta-analysis
- 2.Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O'Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D, Investigators MCN-CCT, Group NCCS (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828. doi: 10.1016/S0140-6736(09)60485-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Wibe A, Moller B, Norstein J, Carlsen E, Wiig JN, Heald RJ, Langmark F, Myrvold HE, Soreide O, Norwegian Rectal Cancer G (2002) A national strategic change in treatment policy for rectal cancer—implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 45(7):857–866CrossRefPubMedGoogle Scholar
- 4.Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Color Dis : Off J Assoc Coloproctology Great Britain Ireland 11(4):354–364 . doi: 10.1111/j.1463-1318.2008.01735.xdiscussion 364-355CrossRefGoogle Scholar
- 12.Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Neuenschwander AU, Vilandt J (2011) Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Color Dis : Off J Assoc Coloproctology Great Britain Ireland 13(10):1123–1129. doi: 10.1111/j.1463-1318.2010.02474.x CrossRefGoogle Scholar
- 13.Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gogenur I, Danish Colorectal Cancer G (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16(2):161–168. doi: 10.1016/S1470-2045(14)71168-4 CrossRefPubMedGoogle Scholar
- 14.Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N (2015) Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg 261(4):708–715. doi: 10.1097/SLA.0000000000000831 CrossRefPubMedGoogle Scholar
- 17.Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, Ma JJ, Li JW, Zang L, Han DP, Zheng MH (2012) Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc 26(12):3669–3675. doi: 10.1007/s00464-012-2435-9 CrossRefPubMedGoogle Scholar
- 18.Galizia G, Lieto E, De Vita F, Ferraraccio F, Zamboli A, Mabilia A, Auricchio A, Castellano P, Napolitano V, Orditura M (2014) 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 Color Dis 29(1):89–97. doi: 10.1007/s00384-013-1766-x CrossRefGoogle Scholar
- 19.Gouvas N, Pechlivanides G, Zervakis N, Kafousi M, Xynos E (2012) Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Color Dis : Off J Assoc Coloproctology Great Britain Ireland 14(11):1357–1364. doi: 10.1111/j.1463-1318.2012.03019.x CrossRefGoogle Scholar
- 24.Matsuda T, Iwasaki T, Mitsutsuji M, Hirata K, Maekawa Y, Tanaka T, Shimada E, Kakeji Y (2015) Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy. Surg Endosc 29(4):1001. doi: 10.1007/s00464-014-3761-x CrossRefPubMedGoogle Scholar
- 25.Melich G, Jeong DH, Hur H, Baik SH, Faria J, Kim NK, Min BS (2014) Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy—analysis of learning curves for a novice minimally invasive surgeon. Can J Surg 57(5):331–336CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Mori S, Baba K, Yanagi M, Kita Y, Yanagita S, Uchikado Y, Arigami T, Uenosono Y, Okumura H, Nakajo A, Maemuras K, Ishigami S, Natsugoe S (2015) Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer. Surg Endosc 29(1):34–40. doi: 10.1007/s00464-014-3650-3 CrossRefPubMedGoogle Scholar
- 28.Munkedal DL, West NP, Iversen LH, Hagemann-Madsen R, Quirke P, Laurberg S (2014) Implementation of complete mesocolic excision at a university hospital in Denmark: an audit of consecutive, prospectively collected colon cancer specimens. Eur J Surg Oncol 40(11):1494–1501. doi: 10.1016/j.ejso.2014.04.004 CrossRefPubMedGoogle Scholar
- 29.Nakajima K, Inomata M, Akagi T, Etoh T, Sugihara K, Watanabe M, Yamamoto S, Katayama H, Moriya Y, Kitano S (2014) Quality control by photo documentation for evaluation of laparoscopic and open colectomy with D3 resection for stage II/III colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol 44(9):799–806. doi: 10.1093/jjco/hyu083 CrossRefPubMedGoogle Scholar
- 30.Perrakis A, Weber K, Merkel S, Matzel K, Agaimy A, Gebbert C, Hohenberger W (2014) Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Color Dis 29(10):1223–1229. doi: 10.1007/s00384-014-1971-2 CrossRefGoogle Scholar
- 32.Shin JW, Amar AH, Kim SH, Kwak JM, Baek SJ, Cho JS, Kim J (2014) Complete mesocolic excision with D3 lymph node dissection in laparoscopic colectomy for stages II and III colon cancer: long-term oncologic outcomes in 168 patients. Tech Coloproctol 18(9):795–803. doi: 10.1007/s10151-014-1134-z CrossRefPubMedGoogle Scholar
- 33.Siani LM, Pulica C (2014) Stage I-IIIC right colonic cancer treated with complete mesocolic excision and central vascular ligation: quality of surgical specimen and long term oncologic outcome according to the plane of surgery. Minerva Chir 69 (4):199–208Google Scholar
- 36.Storli KE, Sondenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I, Eide GE (2014) Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol 18(6):557–564. doi: 10.1007/s10151-013-1100-1 CrossRefPubMedGoogle Scholar
- 37.Takemasa I, Uemura M, Nishimura J, Mizushima T, Yamamoto H, Ikeda M, Sekimoto M, Doki Y, Mori M (2014) Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: a prospective case-control comparison. Surg Endosc 28(4):1110–1118. doi: 10.1007/s00464-013-3284-x CrossRefPubMedGoogle Scholar
- 38.West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28(2):272–278. doi: 10.1200/JCO.2009.24.1448 CrossRefPubMedGoogle Scholar
- 39.West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30(15):1763–1769. doi: 10.1200/JCO.2011.38.3992 CrossRefPubMedGoogle Scholar
- 42.Gao Z, Ye Y, Zhang W, Shen D, Zhong Y, Jiang K, Yang X, Yin M, Liang B, Tian L, Wang S (2013) An anatomical, histopathological, and molecular biological function study of the fascias posterior to the interperitoneal colon and its associated mesocolon: their relevance to colonic surgery. J Anat 223(2):123–132. doi: 10.1111/joa.12066 CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21(15):2912–2919. doi: 10.1200/JCO.2003.05.062 CrossRefPubMedGoogle Scholar
- 46.Ingeholm P (2012) Annual report 2012 of the Danish Colorectal Cancer Group. Danish Colorectal Cancer Group,Google Scholar