Abstract
Complete mesocolic excision (CME) with central vascular ligation (CVL) involves sharp dissection through the embryological planes. However, it may be associated with high mortalities and morbidities especially in colorectal emergencies. This study aimed to investigate the outcomes of CME with CVL in complicated colorectal cancers (CRCs). This was a retrospective study of emergency CRC resection in a tertiary center between March 2016 and November 2018. A total of 46 patients, with a mean age of 51 years, underwent an emergency colectomy for cancer (males, 26 [56.5%]; females, 20 [43.5%]). CME with CVL was performed for all patients. The mean operative time and blood loss were 188 min and 397 mL, respectively. Only five (10.8%) patients presented with burst abdomen, whereas only three (6.5%) presented with anastomotic leakage. The mean length of vascular tie was 8.7 cm, and the mean number of harvested lymph nodes (LNs) was 21.2. Emergency CME with CVL is a safe and feasible technique when performed by a colorectal surgeon and will result in obtaining a superior specimen with a large number of LNs.
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References
Dewulf M, Kalmar A, Vandenberk B, Muysoms F, Defoort B, Claeys D et al (2019) Complete mesocolic excision does not increase short-term complications in laparoscopic left-sided colectomies: a comparative retrospective single-center study. Langenbeck’s Arch Surg 404:557–564
Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82
Koh FH, Tan KK (2019) Complete mesocolic excision for colon cancer: Is it worth it? J Gastrointest Oncol 10:1215–1221
Hohenberger W, Merkel S, Weber K (2007) Lymphadenektomie bei tumoren des unteren gastrointestinaltraktes. Chirurg 78:217–225
West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W 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
Liang JT, Huang KC, Lai HS, Lee PH, Sun CT (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
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 14:1357–1364
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 11:354–364
Tzivanakis A, Moran BJ (2020) Perforated Colorectal Cancer. Clin Colon Rectal Surg 33:247–252
Malakorn S, Stein SL, Lee JH, You YN (2019) Urgent management of obstructing colorectal cancer: divert, stent, or resect? J Gastrointest Surg 23:425–432
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Mori S, Kita Y, Baba K, Yanagi M, Tanabe K, Uchikado Y et al (2018) Laparoscopic complete mesocolic excision via mesofascial separation for left-sided colon cancer. Surg Today 48:274–281
Abdelkhalek M, Setit A, Bianco F, Belli A, Denewer A, Youssef TF et al (2018) Complete mesocolic excision with central vascular ligation in comparison with conventional surgery for patients with colon cancer–the experiences at two centers. Ann Coloproctol 34:180–186
De Simoni O, Barina A, Sommariva A, Tonello M, Gruppo M, Mattara G et al (2021) Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 36:881–892
Ramser M, Kwok AMF, Maeda Y, Potter MA (2021) Oncological and clinical outcomes after conventional right hemicolectomy. Langenbecks Arch Surg 406:2781–2788
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? Colorectal Dis 13:1123–1129
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. Colorectal Dis 14:1357–1364
Biondo S, Gálvez A, Ramírez E, Frago R, Kreisler E (2019) Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol 23:1141–1161
Biondo S, Martí-Ragué J, Kreisler E, Parés D, Martín A, Navarro M et al (2005) A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Sur 189:377–383
Chen TM, Huang YT, Wang GC (2017) Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol 15:164
Zedan A, Elshiekh E, Omar MI, Raafat M, Khallaf SM, Atta H, Hussien MT (2021) Laparoscopic versus open complete mesocolic excision for right colon cancer. Int J Surg Oncol 2021:8859879
Huang JL, Wei HB, Fang JF, Zheng ZH, Chen TF, Wei B et al (2015) Comparison of laparoscopic versus open complete mesocolic excision for right colon cancer. Int J Surg 23:12–17
Kim IY, Kim BR, Choi EH, Kim YW (2016) Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation. Int J Surg 27:151–157
Han DP, Lu AG, Feng H, Wang PX, Cao QF, Zong YP et al (2014) Long-term outcome of laparoscopic-assisted right-hemicolectomy with D3 lymphadenectomy versus open surgery for colon carcinoma. Surg Today 44:868–874
Storli KE, Eide GE (2016) Laparoscopic complete mesocolic excision versus open complete mesocolic excision for transverse colon cancer: long-term survival results of a prospective single centre non-randomized study. Dig Surg 33:114–120
Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW et al (2018) Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc 32:2721–2731
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 28:272–278
Azin A, Hirpara DH, Draginov A, Khorasani M, Patel SV, O’Brien C et al (2021) Adequacy of lymph node harvest following colectomy for obstructed and nonobstructed colon cancer. J Surg Oncol 123:470–478
Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C et al (2017) Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg 21:543–553
Porter GA, Urquhart R, Bu J, Johnson P, Grunfeld E (2011) The impact of audit and feedback on nodal harvest in colorectal cancer. BMC Cancer 11:2
Lindboe CF (2011) Lymph node harvest in colorectal adenocarcinoma specimens: the impact of improved fixation and examination procedures. APMIS 119:347–355
West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865
Siani LM, Garulli G (2017) The importance of the mesofascial interface in complete mesocolic excision. Surgeon 15:240–249
Munkedal DLE, 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 40:149
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All authors contributed to the study conception and design. Material preparation and data collection were performed by Radwan Abdelsabour Torky, Mohamed Abdeltawab, and Ahmed Mubarak Hifni. Data analysis was done by Abadeer Rafaat and Ahmed Abdelmotaleb. The first draft of the manuscript was written by Radwan Abdelsabour Torky, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Torky, R.A., Abdel-Tawab, M., Rafaat, A. et al. Efficacy and Feasibility of Complete Mesocolic Excision with Central Vascular Ligation in Complicated Colorectal Cancer. Indian J Surg Oncol 14, 312–317 (2023). https://doi.org/10.1007/s13193-022-01673-w
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DOI: https://doi.org/10.1007/s13193-022-01673-w