Eva Lieto1, Mohamed Abdelkhalek2, Michele Orditura3, Adel Denewer2, Paolo Castellano1, Tamer F Youssef2, Annamaria Auricchio1, Ahmed Setit2, Gennaro Galizia4. 1. Division of Surgical Oncology, Department of Cardio-Thoracic and Respiratory Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy. 2. Division of Surgical Oncology, Oncology Center Mansoura University, Mansoura, Egypt. 3. Division of Medical Oncology, "F. Magrassi" Department of Clinical and Experimental, Medicine and Surgery Surgical Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy. 4. Division of Surgical Oncology, Department of Cardio-Thoracic and Respiratory Sciences, School of Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy - gennaro.galizia@unicampania.it.
Abstract
BACKGROUND: The prognosis of right colon cancer remains disappointing. Complete mesocolic excision (CME) with central vascular ligation (CVL), based on the same oncological principles of total mesorectal excision, has been speculated to result in a better outcome. To evaluate the oncological adequacy of CME with CVL, we carried out a comparative study with propensity score-matched analysis between two different surgical procedures performed at Italian and Egyptian University cancer centers. METHODS: Forty-six Egyptian patients underwent conventional right hemicolectomy, while eighty-eight Italian patients underwent CME with sharp dissection between the embryological planes, exposure of the superior mesenteric vessels with extended lymphadenectomy, and CVL. RESULTS: All operations were successful with no increase in postoperative complications (10% in the patients undergoing CME vs. 19.5% in Egyptian patients). Number of harvested nodes (21 vs. 13) and lymph node ratio (0.08 vs. 0.22) were significantly different in patients undergoing CME (P=0.0001 and P=0.005, respectively). In these patients, the risk of cancer relapse was reduced to as much as one third (8% vs. 22%), even in node-positive tumors, and locoregional recurrences were never experienced. The classic operation was significantly associated with poor outcome (5-year disease-free survival rates were 89.2% in the group undergoing CME and 49.1% in the classic group, P=0.02). Propensity score-matched analysis warranted optimal balance and confirmed overall results. CONCLUSIONS: Right colon cancer patients undergoing CME benefitted from more oncological adequacy, with no increased postoperative complication rate, a decreased locoregional recurrence rate, and a better long-term outcome than patients operated on with the conventional procedure.
BACKGROUND: The prognosis of right colon cancer remains disappointing. Complete mesocolic excision (CME) with central vascular ligation (CVL), based on the same oncological principles of total mesorectal excision, has been speculated to result in a better outcome. To evaluate the oncological adequacy of CME with CVL, we carried out a comparative study with propensity score-matched analysis between two different surgical procedures performed at Italian and Egyptian University cancer centers. METHODS: Forty-six Egyptian patients underwent conventional right hemicolectomy, while eighty-eight Italian patients underwent CME with sharp dissection between the embryological planes, exposure of the superior mesenteric vessels with extended lymphadenectomy, and CVL. RESULTS: All operations were successful with no increase in postoperative complications (10% in the patients undergoing CME vs. 19.5% in Egyptian patients). Number of harvested nodes (21 vs. 13) and lymph node ratio (0.08 vs. 0.22) were significantly different in patients undergoing CME (P=0.0001 and P=0.005, respectively). In these patients, the risk of cancer relapse was reduced to as much as one third (8% vs. 22%), even in node-positive tumors, and locoregional recurrences were never experienced. The classic operation was significantly associated with poor outcome (5-year disease-free survival rates were 89.2% in the group undergoing CME and 49.1% in the classic group, P=0.02). Propensity score-matched analysis warranted optimal balance and confirmed overall results. CONCLUSIONS:Right colon cancerpatients undergoing CME benefitted from more oncological adequacy, with no increased postoperative complication rate, a decreased locoregional recurrence rate, and a better long-term outcome than patients operated on with the conventional procedure.
Authors: Sara Sakjah; Anna Sofie Friis Olsen; Anders Kierkegaard Gundestrup; Pernille Wolder Born; Birgitte Bols; Peter Ingeholm; Jakob Kleif; Claus Anders Bertelsen Journal: Colorectal Dis Date: 2022-04-08 Impact factor: 3.917
Authors: G Anania; R J Davies; F Bagolini; N Vettoretto; J Randolph; R Cirocchi; A Donini Journal: Tech Coloproctol Date: 2021-06-12 Impact factor: 3.781