Complete mesocolic excision does not increase short-term complications in laparoscopic left-sided colectomies: a comparative retrospective single-center study
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Since the implementation of total mesorectal excision (TME) in rectal cancer surgery, oncological outcomes improved dramatically. With the technique of complete mesocolic excision (CME) with central vascular ligation (CVL), the same surgical principles were introduced to the field of colon cancer surgery. Until now, current literature fails to invariably demonstrate its oncological superiority when compared to conventional surgery, and there are some concerns on increased morbidity. The aim of this study is to compare short-term outcomes after left-sided laparoscopic CME versus conventional surgery.
In this retrospective analysis, data on all laparoscopic sigmoidal resections performed during a 3-year period (October 2015 to October 2018) at our institution were collected. A comparative analysis between the CME group—for sigmoid colon cancer—and the non-CME group—for benign disease—was performed.
One hundred sixty-three patients met the inclusion criteria and were included for analysis. Data on 66 CME resections were compared with 97 controls. Median age and operative risk were higher in the CME group. One leak was observed in the CME group (1/66) and 3 in the non-CME group (3/97), representing no significant difference. Regarding hospital stay, postoperative complications, surgical site infections, and intra-abdominal collections, no differences were observed. There was a slightly lower reoperation (1.5% versus 6.2%, p = 0.243) and readmission rate (4.5% versus 6.2%, p = 0.740) in the CME group during the first 30 postoperative days. Operation times were significantly longer in the CME group (210 versus 184 min, p < 0.001), and a trend towards longer pathological specimens in the CME group was noted (21 vs 19 cm, p = 0.059).
CME does not increase short-term complications in laparoscopic left-sided colectomies. Significantly longer operation times were observed in the CME group.
KeywordsColonic neoplasm Sigmoid neoplasm Complete mesocolic excision Central vascular ligation Laparoscopic surgery
Maxime Dewulf: study conception and design, acquisition of data, analysis and interpretation of data, and drafting of manuscript. Alain Kalmar: analysis and interpretation of data and critical revision of manuscript. Bert Vandenberk: analysis and interpretation of data and critical revision of manuscript. Filip Muysoms: critical revision of manuscript. Barbara Defoort: acquisition of data. Donald Claeys: acquisition of data. Pieter Pletinckx: study conception and design, acquisition of data, analysis and interpretation of data, and critical revision of manuscript.
Compliance with ethical standards
Conflict of interest
Drs. Maxime Dewulf, Bert Vandenberk, Barbara Defoort, Donald Claeys, and Pieter Pletinckx have no conflicts of interest or financial ties to disclose. Dr. Alain Kalmar reports having patents on steerable laparoscopic instruments. Dr. Filip Muysoms reports having received research grants from Medtronic and Dynamesh; received speakers honorarium from Medtronic, Bard-Davol, Dynamesh, and Intuitive Surgical; and received consultancy fees from Medtronic, Intuitive Surgical, and CMR Surgical.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the local ethics committee (ethics committee Maria Middelares, Ghent, Belgium—Reference Number MMS.2018.063) before the start of data collection.
In this retrospective analysis, all data were gathered and processed in an anonymized manner. In accordance with national regulations and after consultation of the ethics committee, a specific written informed consent for this study was not obtained.
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