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Oncological and clinical outcomes after conventional right hemicolectomy

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Abstract

Purpose

Complete mesocolic excision (CME) has been proposed for better local control of colon cancer and to improve cancer-specific survival (CSS). However, CME may be associated with increased morbidity from bleeding during central vascular ligation. This study aimed to investigate the outcome of conventional right hemicolectomy, a traditional anatomical dissection along anatomical planes with radical excision of the central lymph nodes at the level of the origin of colic artery but without exposure of superior mesenteric vein and artery (SMV/SMA).

Method

This was a retrospective review of a cohort of all elective right hemicolectomies performed at a specialist tertiary unit during a five-year period (2011–2015).

Results

Five-hundred-nineteen patients (271 female, a median age of 73.0 years (interquartile range (IQR) 65.0–80.0)) were included (Stage I disease: 2.7%, stage II: 53.2%, stage III: 33.3%, stage IV: 10.8%). At the latest follow-up (a median 47 months (IQR 29–67)), local recurrence occurred in 34 patients (6.6%). Three-year overall survival was 74.4% and 3-year CSS was 85.9%. Subgroup analysis for stage I–III showed local recurrence in 6.0%, sole distant recurrence in 7.6% while 19 patients (4.1%) suffered concomitant local and distant recurrence. The anastomotic leak rate was 1.0% and perioperative bleeding occurred in 1.2%.

Conclusions

Oncological outcomes comparable to those of CME can be achieved by conventional surgery but with low rates of bleeding complications and anastomotic leakage. The proposed advantages of CME should be carefully considered and balanced against patients’ co-morbidities and potential complications.

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Data and materials availability

The datasets generated analysed during the current study are subject to protection of patient confidentiality, thus not publicly available as per regulations set by the local audit committee.

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Acknowledgements

The authors would like to thank Sarah Buchan (South East Scotland Cancer Network) for her assistance in extracting cancer data set from the prospective database.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Western General Hospital, Crewe Rd South, Edinburgh, EH4 2XU, UK

    Michaela Ramser, Allan M. F. Kwok, Yasuko Maeda & Mark A. Potter

  2. Department of General Surgery, Kantonsspital Olten, Olten, Switzerland

    Michaela Ramser

  3. Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK

    Yasuko Maeda & Mark A. Potter

Authors
  1. Michaela Ramser
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  2. Allan M. F. Kwok
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  3. Yasuko Maeda
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  4. Mark A. Potter
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Michaela Ramser, Allan Kwok and Yasuko Maeda. The first draft of the manuscript was written by all authors. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yasuko Maeda.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the responsible local audit committee and conducted according to applicable law as well as good clinical practice and the Declaration of Helsinki.

Consent for publication

As per approval by the local audit committee, specific consent for participation/publication was not required due to use of anonymised data.

Conflict of interest

Yasuko Maeda has received research grant from Medtronic, speaker honorarium from Astellas and consultant fee from Creo Medical.

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Michaela Ramser and Allan M. F. Kwok shared first authorship, authors contributed equally to this manuscript

On behalf of the Department of Colorectal Surgery, Western General Hospital, Edinburgh

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Ramser, M., Kwok, A.M.F., Maeda, Y. et al. Oncological and clinical outcomes after conventional right hemicolectomy. Langenbecks Arch Surg 406, 2781–2788 (2021). https://doi.org/10.1007/s00423-021-02320-8

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  • DOI: https://doi.org/10.1007/s00423-021-02320-8

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