Long-term results following an anatomically based surgical technique for resection of colon cancer: a comparison with results from complete mesocolic excision

• Published in: Colorectal disease 2016-07, Vol.18 (7), p.676-683
• Main Authors: Bokey, L., Chapuis, P. H., Chan, C., Stewart, P., Rickard, M. J. F. X., Keshava, A., Dent, O. F.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Colectomy - methods; Colon - anatomy & histology; Colon - surgery; Colonic Neoplasms - surgery; Combined Modality Therapy; Complete mesocolic excision; Dissection - methods; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Ligation - methods; Lymph Node Excision - statistics & numerical data; Lymph Nodes - surgery; Male; Mesocolon - surgery; Middle Aged; Postoperative Complications; Prospective Studies; recurrence; Registries; survival; Survival Rate; Time; Treatment Outcome; Young Adult
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13159

Aim Complete mesocolic excision (CME) has been advocated as likely to improve the long‐term oncological outcome of colon cancer resection, although there is a paucity of long‐term results in the literature. The aim of this study was to supplement our previously published results on colon cancer resection based on a standardized technique of precise dissection along anatomical planes with high vascular ligation and to compare our long‐term results with those of recent European studies of CME. Method Data were drawn from a prospective hospital registry of consecutive resections for colon cancer between 1996 and 2007, including follow‐up to the end of 2012. The principal outcomes from potentially curative resections were 5‐year Kaplan–Meier rates of local recurrence, systemic recurrence, overall survival and cancer‐specific survival. Secondary outcomes for all resections were postoperative complications, number of lymph nodes retrieved and R0 status. Results For 779 potentially curative resections the local recurrence rate was 2.1% (95% CI 1.3–3.4), the systemic recurrence rate was 10.2% (95% CI 8.1–12.7), the 5‐year overall survival rate was 76.2% (95% CI 73.0–79.0) and the cancer‐specific survival rate was 89.8% (95% CI 87.3–91.9). For all 905 resections, rates of 14 surgical complications were low and not dissimilar to those in a comparable study. The median lymph node count was 15 (range 0–113). R0 status was confirmed in 883/905 patients (97.6%; 95% CI 96.4–98.5). Conclusion For colon cancer, meticulous dissection along anatomical planes together with high vascular ligation results in few complications, a high R0 rate, low recurrence and high survival.