Complete mesocolic excision during right hemicolectomy
Authors:
V. Procházka 1
; A. Zetelova 1; T. Grolich 1; L. Frola 2; Z. Kala 1
Authors place of work:
Chirurgická klinika LF Masarykovy univerzity Brno a FN Brno-Bohunice, přednosta: prof. MUDr. Z. Kala, CSc.
1; Patologicko-anatomický ústav LF Masarykovy univerzity Brno a FN Brno-Bohunice, přednosta: doc. MUDr. L. Křen, Ph. D.
2
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 10, s. 359-364.
Category:
Original articles
Summary
Introduction:
Complete mesocolic excision (CME) ensures the removal of all sentinel and regional lymph nodes during colon cancer surgery. For right-sided hemicolectomy it is essential to dissect the wall of vena mesenterica superior, which increases the risk of injuring surrounding organs. So far, no randomized studies comparing long-term oncological results of standard right hemicolectomy and hemicolectomy with CME have been published.
Method:
83 patients operated for colon carcinoma in 2014 and 2015 were included in this study, all of them undergoing right-sided hemicolectomy using laparotomy access. The standard procedure was done in 63 cases and hemicolectomy with CME was done in 20 cases. We compared the incidence of complications, and the characteristics and descriptions of obtained specimens evaluated by a pathologist for both groups.
Results:
The operation times of right-sided hemicolectomies with CME was longer by 20 minutes on average. The incidence of postoperative complications was similar in both groups. Pancreatic fistula in the group of patients undergoing right-sided hemicolectomy with CME was an unusual complication; the fistula was healed through conservative treatment. Comparing the resecate parameters, we found no significant differences in the lengths of the resected terminal ileum. But the length of the resected colon was significantly longer for the CME technique (median 42 cm versus 22 cm). The incidence of lymph node metastases was similar in both groups. However, the total number of removed lymph nodes in the group with CME was significantly higher (median 23).
Conclusion:
Right-sided hemicolectomy with complete mesocolic excision offers the removal of more lymph nodes than the standard technique. The central vascular ligation technique elongates the operation time and may be associated with more intraoperative injuries. Introduction of the concept of complete mesocolic excision is derived from an effort to standardize the surgical technique for colon cancer resection.
Key words:
right-sided hemicolectomy − complete mesocolic excision − colon cancer −lymphadenectomy
Zdroje
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