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Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study
Author(s) -
Testa Domenica Carmen,
Mazzola Lorenzo,
di Martino Giuseppe,
Cotellese Roberto,
Selvaggi Federico
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.17264
Subject(s) - medicine , ligation , adenocarcinoma , retrospective cohort study , surgery , general surgery , cancer
Background To examine the outcome of patients treated with complete mesocolic excision (CME) with central vascular ligation (CVL) after conventional and laparoscopic surgery. Methods We retrospectively evaluated stage I–IV colon adenocarcinoma patients treated by the same surgeon (L.M.) from 2013 to 2018. Postoperative complications, recurrences and survival are assessed. Results Fifty‐one patients (M/F: 24/27) underwent laparoscopic right hemicolectomy with CME (L‐CME) or open CME (O‐CME) plus CVL. Tumour location was the caecum in 39.2% of cases, the transverse in 23.5%, the hepatic colonic flexure in 21.5%, and the ascending colon in 15.6%. Twenty‐four patients underwent L‐CME while 27 underwent O‐CME. More than 15 harvested lymphnodes are reported in 74.1% of O‐CME patients and in 66.7% of L‐CME patients ( p = 0.562). Postoperative complications occurred in 7 O‐CME and 5 L‐CME patients, respectively ( p = 0.669). Three‐year overall survival, including stage IV, was of 75% versus 77.8% for L‐CME and O‐CME patients, respectively, while for stage I–III, was of 88.9% vs. 80% in L‐CME and O‐CME, respectively ( p = 0.440). The median follow‐up was of 2.43 years. Conclusion CME with CVL is a meticulous, complex but feasible technique. In our experience, oncological results in terms of recurrences and overall survival, after conventional and laparoscopic CME plus CVL, are comparable. Patients with stage I–III colon adenocarcinoma have a better prognostic trend especially when more than 15 lymphnodes are removed. The respect of oncological radicality and the correct indication to minimally invasive surgery are the undiscussed key outcome variables.