Skip to main content

Advertisement

SpringerLink
Log in

Ausmaß und Technik der chirurgischen Resektion beim Kolonkarzinom

Extent and technique of surgical resection for colon cancer

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Die chirurgische Therapie stellt beim Kolonkarzinom nach wie vor die Therapie der Wahl dar. Zentrales Element einer kurativ intendierten Therapie ist hierbei für alle Kolonkarzinome – mit Ausnahme von pT1-Karzinomen in der Low-risk-Situation – die En-bloc-Resektion des tumortragenden Kolonsegmentes mit einer systematischen Lymphadenektomie sowie der zentralen Ligatur der versorgenden Stammgefäße. Minimal-invasive Operationstechniken haben die postoperativen, kurzfristigen Ergebnisse verbessert. Das Konzept der kompletten mesokolischen Exzision (CME) zielt in Analogie zur totalen mesorektalen Exzision (TME) beim Rektumkarzinom auf eine maximale Reduktion der Lokalrezidivrate ab. Es umfasst zum einen die Wahrung der Integrität des Mesokolons durch eine exakte Präparation entlang der embryonalen Schichten und somit eine Schonung der beiden mesokolischen Faszienblätter, um eine mögliche Tumorzelldissemination zu vermeiden. Zum anderen wird durch die zentrale Ligatur der segmentalen Gefäße mit erweiterter Dissektion der D3-Lymphknotenstationen die Anzahl der resezierten Lymphknoten erhöht. Wenngleich eine adäquate CME mit einer geringeren Lokalrezidivrate assoziiert ist, so ist zum gegenwärtigen Zeitpunkt die Evidenz hinsichtlich onkologischer Langzeitergebnisse noch unklar. Darüber hinaus ist nicht gesichert, ob alle Tumorstadien von einer CME profitieren. Unter dem Aspekt einer möglicherweise erhöhten perioperativen Morbidität durch die Erweiterung der Lymphadenektomie ist eine Risiko-Nutzen-Abwägung der CME zu diskutieren.

Abstract

Surgery is still the therapy of choice for colon cancer. The central element of a curative therapy for all types of colon cancer—with the exception of pT1 tumors in the low-risk situation—is the en bloc resection of the tumor-bearing colon segment with a systematic lymphadenectomy and the central ligature of the corresponding main vessels. Minimally invasive surgical techniques have improved postoperative, short-term outcomes. In analogy to total mesorectal excision (TME) in rectal cancer, the concept of complete mesocolic excision (CME) aims to achieve a maximum reduction in the local recurrence rate. On the one hand, it includes preserving the integrity of the mesocolon through precise dissection along the embryonic layers and thus protecting the two mesocolic fascia layers in order to avoid possible tumor cell dissemination. On the other hand, the number of resected lymph nodes is increased by the central ligature of the segmental vessels with extended dissection of the D3 lymph node stations. Although adequate CME is associated with a lower local recurrence rate, the evidence regarding long-term oncological outcomes is still unclear. In addition, it is not certain whether all tumor stages benefit from CME. A risk–benefit analysis of CME should be discussed under the aspect of a possibly increased perioperative morbidity with this demanding concept.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Grinnell RS (1966) Lymphatic block with atypical and retrograde lymphatic metastasis and spread in carcinoma of the colon and rec-tum. Ann Surg 163:272–280

    Article  CAS  Google Scholar 

  2. Lee YJ, Huh JW, Shin JK, Park YA, Cho YB, Kim HC et al (2020) Risk factors for lymph node metastasis in early colon cancer. Int J Colorectal Dis 35:1607–1613

    Article  Google Scholar 

  3. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AMH, UK MRC CLASICC Trial Group et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3‑year results of the UK MRC CLASICC trial group. J Clin Oncol 25(21):3061–3068

    Article  Google Scholar 

  4. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484

    Article  Google Scholar 

  5. Storli KE, Sondenaa K, Furnes B et al (2013) Outcome after introduction of complete mesocolic excision for colon cancer is similar for open and laparoscopic surgical treatments. Dig Surg 30:317–327

    Article  Google Scholar 

  6. Cho MS, Baek SJ, Hur H et al (2015) Modifiedcomplete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg 261:708–715

    Article  Google Scholar 

  7. Yamamoto S, Inomata M, Katayama H et al (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/ III colon cancer: Japan clinical oncology group study JCOG 0404. Ann Surg 260:23–30

    Article  Google Scholar 

  8. Anania G, Arezzo A, Davies RJ, Marchetti F, Zhang S, Di Saverio S, Cirocchi R, Donini A (2021) A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision. Int J Colorectal Dis 36(8):1609–1620

    Article  Google Scholar 

  9. Di Buono G, Buscemi S, Cocorullo G, Sorce V, Amato G, Bonventre G, Maienza E, Galia M, Gulotta L, Romano G, Agrusa A (2021) Feasibility and safety of laparoscopic complete mesocolic excision (CME) for right-sided colon cancer: short-term outcomes. A randomized clinical study. Ann Surg 274(1):57–62

    Article  Google Scholar 

  10. Siddiqi N, Stefan S, Jootun R, Mykoniatis I, Flashman K, Beable R, David G, Khan J (2021) Robotic complete mesocolic excision (CME) is a safe and feasible option for right colonic cancers: short and midterm results from a single-centre experience. Surg Endosc 35(12):6873–6881

    Article  Google Scholar 

  11. Bianchi PP, Salaj A, Giuliani G, Ferraro L, Formisano G (2021) Feasibility of robotic right colectomy with complete mesocolic excision and intracorporeal anastomosis: short-term outcomes of 161 consecutive patients. Updates Surg 73(3):1065–1072

    Article  Google Scholar 

  12. Adamina M, Manwaring ML, Park KJ et al (2012) Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc 26:2976–2980

    Article  Google Scholar 

  13. West NP, Kobayashi H, Takahashi K et al (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769

    Article  Google Scholar 

  14. Crane J, Hamed M, Borucki JP, El-Hadi A, Shaikh I, Stearns AT (2021) Complete mesocolic excision versus conventional surgery for colon cancer: a systematic review and meta-analysis. Colorectal Dis 23:1670–1686

    Article  Google Scholar 

  15. Galizia G, Lieto E, De Vita F et al (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 Colorectal Dis 29:89–97

    Article  Google Scholar 

  16. Bertelsen CA, Bols B, Ingeholm P et al (2011) Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Colorectal Dis 13:1123–1129

    Article  CAS  Google Scholar 

  17. Eiholm S, Ovesen H (2010) Total mesocolic excision versus traditional resection in right-sided colon cancer—method and increased lymph node harvest. Dan Med Bull 57:A4224

    PubMed  Google Scholar 

  18. Moore J, Hyman N, Callas P et al (2010) Staging error does not explain the relationship between the number of lymph nodes in a colon cancer specimen and survival. Surgery 147:358–365

    Article  Google Scholar 

  19. Gouvas N, Pechlivanides G, Zervakis N et al (2012) Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Colorectal Dis 14:1357–1364

    Article  CAS  Google Scholar 

  20. Liang JT, Huang KC, Lai HS et al (2007) Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol 14:1980–1990

    Article  Google Scholar 

  21. Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, Arai M, Ueno M (2015) Prognostic impact of distribution of lymph node metastases in stage III colon cancer. World J Surg 39:3008–3015

    Article  Google Scholar 

  22. Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H et al (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: 20 proceedings of a consensus conference. Int J Colorectal Dis 29:419–428

    Article  Google Scholar 

  23. Zenger S, Aytac E, Gurbuz B, Ozben V, Ozoran E, Baca B, Balik E, Hamzaoglu I, Karahasanoglu T, Bugra D (2021) 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 25(3):309–317

    Article  Google Scholar 

  24. Díaz-Vico T, Fernández-Hevia M, Suárez-Sánchez A, García-Gutiérrez C, Mihic-Góngora L, Fernández-Martínez D, Álvarez-Pérez JA, Otero-Díez JL, Granero-Trancón JE, García-Flórez LJ (2021) Complete mesocolic excision and D3 Lymphadenectomy versus conventional colectomy for colon cancer: a systematic review and meta-analysis. Ann Surg Oncol 28(13):8823–8837

    Article  Google Scholar 

  25. Ow ZGW, Sim W, Nistala KRY, Ng CH, Koh FH, Wong NW, Foo FJ, Tan KK, Chong CS (2021) Comparing complete mesocolic excision versus conventional colectomy for colon cancer: a systematic review and meta-analysis. Eur J Surg Oncol 47(4):732–737

    Article  Google Scholar 

  26. Bertelsen CA, Neuenschwander AU, Jansen JE et al (2016) Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg 103:581–589

    Article  CAS  Google Scholar 

  27. Freund MR, Edden Y, Reissman P et al (2016) Iatrogenic superior mesenteric vein injury: the perils of high ligation. Int J Colorectal Dis 31:1649–1651

    Article  CAS  Google Scholar 

  28. Olofsson F, Buchwald P, Elmstahl S, Syk I (2016) No benefit of extended mesenteric resection with central vascular ligation in right-sided colon cancer. Colorectal Dis 18:773–778

    Article  CAS  Google Scholar 

  29. Bertelsen CA, Neuenschwander AU, Jansen JE et al (2019) 5‑year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study. Lancet Oncol 20(11):1556–1565

    Article  Google Scholar 

  30. De Simoni O, Barina A, Sommariva A, Tonello M, Gruppo M, Mattara G, Toniato A, Pilati P, Franzato B (2021) Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 36(5):881–892. https://doi.org/10.1007/s00384-020-03797-3

    Article  PubMed  Google Scholar 

  31. Son GM, Lee IY, Lee YS, Kye BH, Cho HM, Jang JH, Kim CN, Lee KY, Lee SH, Kim JG, Korean Laparoscopic Colorectal Surgery Study Group (2021) Is laparoscopic complete mesocolic excision and central vascular ligation really necessary for all patients with right-sided colon cancer? Ann Coloproctol 37(6):434–444

    Article  Google Scholar 

  32. Kong JC, Prabhakaran S, Choy KT, Larach JT, Heriot A, Warrier SK (2021) Oncological reasons for performing a complete mesocolic excision: a systematic review and meta-analysis. ANZ J Surg 91:124–131

    Article  Google Scholar 

  33. Benz S (2017) Laparoskopische Hemikolektomie rechts mit kompletter mesokolischer Exzision (CME). Minimal-invasive Viszeralchirurgie, 1. Aufl. Springer, https://doi.org/10.1007/978-3-662-53204-1German

    Book  Google Scholar 

  34. Strey CW, Wullstein C, Adamina M, Agha A, Aselmann H, Becker T, Grutzmann R, Kneist W, Maak M, Mann B, Moesta KT, Runkel N, Schafmayer C, Turler A, Wedel T, Benz S (2018) Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept. Surg Endosc 32(12):5021–5030

    Article  Google Scholar 

  35. Benz S (2021) Konzept der standardisierten laparoskopischen Hemikolektomie rechts mit CME. In: Benz S, Grützmann R, Stinner B (Hrsg) Chirurgie des Kolonkarzinoms. Springer, Berlin, S 157

    Chapter  Google Scholar 

  36. Alhassan N, Yang M, Wong-Chong N et al (2019) Comparison between conventional colectomy and complete mesocolic excision for colon cancer: a systematic review and pooled analysis: a review of CME versus conventional colectomies. Surg Endosc 33:8–18

    Article  Google Scholar 

  37. Balciscueta Z, Balciscueta I, Uribe N, Pellino G, Frasson M, García-Granero E (2021) D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis. Eur J Surg Oncol 47(7):1541–1551

    Article  Google Scholar 

  38. Kim JS, Baek SJ, Kwak JM, Kim J, Kim SH, Ji WB, Kim JS, Hong KD, Um JW, Kang SH, Lee SI, Min BW (2021) Impact of D3 lymph node dissection on upstaging and short-term survival in clinical stage I right-sided colon cancer. Asian J Surg 44(10):1278–1282

    Article  Google Scholar 

  39. Xu L, Su X, He Z, Zhang C, Lu J, Zhang G, Sun Y, Du X, Chi P, Wang Z, Zhong M, Wu A, Zhu A, Li F, Xu J, Kang L, Suo J, Deng H, Ye Y, Ding K, Xu T, Zhang Z, Zheng M, Xiao Y, RELARC Study Group (2021) Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol 22(3):391–401

    Article  Google Scholar 

  40. West NP, Morris EJA, Rotimi O, Cairns A, Finan P, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein- und Viszeralchirurgie, St. Joseph Krankenhaus Berlin Tempelhof, Wüsthoffstr. 15, 12101, Berlin, Deutschland

    Christoph Holmer

Authors
  1. Christoph Holmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christoph Holmer.

Ethics declarations

Interessenkonflikt

C. Holmer gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Holmer, C. Ausmaß und Technik der chirurgischen Resektion beim Kolonkarzinom. coloproctology 44, 149–155 (2022). https://doi.org/10.1007/s00053-022-00605-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00053-022-00605-0

Schlüsselwörter

Keywords

Search

Navigation