Minimally-Invasive Conventional Right Colectomy Versus Complete Mesocolic Excision for Right-Colon Adenocarcinoma: A Single-Institution Cohort

TL;DR

This study compares two surgical techniques for right colon cancer and finds that complete mesocolic excision may reduce recurrence and improve survival.

Contribution

The study provides evidence that minimally invasive complete mesocolic excision reduces nodal recurrence and improves disease-free survival in right colon cancer.

Findings

CME was associated with a significant reduction in nodal recurrence risk.

CME improved disease-free survival in patients with advanced-stage disease.

CME had a similar safety profile but increased lymph node yield.

Abstract

Introduction: The benefits of complete mesocolic excision (CME) versus conventional right colectomy in right-sided colon cancer remain to be defined, as these relate to reduced nodal recurrence and increased disease-free survival (DFS). Optimal patient selection also appears crucial in selecting the best surgical technique for right colon cancer.

Methods: A prospective, single-center database analyzing minimally invasive CME versus conventional colectomy in right-sided colon cancer was retrospectively analyzed. Only patients with free surgical margins and without distant metastases were included for analysis. The outcomes analyzed comprised local recurrence, nodal recurrence, DFS, length of stay, node harvesting, and major postoperative complications. The analysis was adjusted for multiple confounders, including age, sex, BMI, pathological T stage, pathological N stage, mismatch repair protein deficiency, adjuvant chemotherapy, first postoperative carcinoembryonic antigen (CEA) level, and American Society of Anesthesiologists Physical Status Classification System (ASA) score.

Results: CME presented a similar safety profile, with increased lymph node yield. CME was associated with a significant reduction in the risk of nodal recurrence (adjusted relative risk (RR) = 0.08; 95% CI: 0.05 to 0.09; p < 0.001). Moreover, in the propensity score matching (PSM) analysis, CME was associated with a significant coefficient of reduction for nodal recurrence (Coef. = -0.14; 95% CI: -0.23 to -0.05; p = 0.01). An improvement in DFS was also observed (hazard ratio (HR) = 0.03; 95% CI: 0.003 to 0.27; p = 0.002) in patients with pT3/pT4 or pN+ disease.

Conclusion: Minimally invasive CME may be associated with decreased nodal recurrence and increased DFS in patients with right colon cancer.

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