Disease recurrence after right hemicolectomy in Scotland: Is there rationale to adopt complete mesocolic excision (CME)?

• Published in: The surgeon (Edinburgh) 2022-10, Vol.20 (5), p.301-308
• Main Authors: H M Metcalfe, Kiloran, Knight, Katrina, McIntosh, Stuart, Hunter, Ross, MacKay, Craig, McCabe, Gerard, Sahni, Dhruv, Ramsay, George, Roxburgh, Campbell, Richards, Colin
• Format: Article
• Language: English
• Subjects: Colorectal cancer; Complete mesocolic excision; Long term outcomes; Recurrence
• ISSN: 1479-666X; 2405-5840
• DOI: 10.1016/j.surge.2021.09.009

Complete mesocolic excision (CME) has been proposed as a way to improve the oncological outcomes in patients with colon cancer. To investigate whether there is rationale for adopting the technique in Scotland, our aim was to define the incidence of disease recurrence following standard right hemicolectomy and to compare this with published CME outcomes. Data was collected on consecutive patients undergoing right or extended right hemicolectomy for colonic adenocarcinoma (2012–2017) at three hospitals in Scotland (Raigmore Hospital, Aberdeen Royal Infirmary and Glasgow Royal Infirmary). Emergency or palliative surgery was excluded. Patients were followed up with CT scans and colonoscopy for a minimum of 3 years. 689 patients (M 340, F 349) were included. 30-day mortality was 1.6%. Final pathological stage was Stage I (14%), Stage II (49.8%) and Stage III (36.1%). During follow-up, 10.5% developed loco-regional recurrence and 12.2% developed distant metastases. The 1, 3 and 5-year disease-free survival (DFS) was 94%, 84% and 82% respectively. Primary determinants of recurrence were T stage (p