Complete Mesocolic Excision and Central Vascular Ligation in Colon Cancer Surgery, Feasibility and Outcome
Background: Colon cancer continues to be a major health problem worldwide. Being the third most common type of cancer in men and the second in women. Standard treatment of colon cancer is based on surgical resection. An adequate number of lymph nodes harvested are important for a correct stabili- zation of the disease; thereby the extension of the colonic resection remains controversial. Complete mesocolic excision (CME) with central vascular liga- tion (CVL) has recently been found to improve on- cological outcomes in patient with colonic cancer. Complete mesocolic excision is based on a correct identification of the dissection plan between the me- sofascial plane and the retroperitoneal fascia, cen- tral vascular ligation of the vessels to remove vertical lymph nodes and resection of the affected colonic segment. Methods: This is a prospective study done at general surgery department of Fayoum University hospitals from January 2015 to January 2019 includ- ing 60 patients with operable colonic cancer operat- ed with adequate surgical margin, complete meso- colic excision and high vascular ligation. Results: The number of dissected lymph node was 27.7 ± 4.2 and this number is more than that dissected in the con- ventional colectomy mentioned in many studies in literature, more over larger mesocolon area, longer distance from vascular high ligation point to intesti- nal wall, and longer distance from vascular high liga- tion point to tumor center were observed. Conclu- sion: Surgery in colon cancer patients remains the only curative treatment and applying the principles of complete mesocolic excision and central vascular ligation in colon cancer surgery can improve cancer outcomes without increase the incidence of postop- erative complications. The colonic mesentery or mesocolon contains the vascular and the lymphatic drainage systems of the colon, so adequate clearance is necessary for colon cancer to have the same oncologic benefit as a to- tal mesorectal excision for the treatment of patients with rectal cancer. In 2009, Hohenberger et al. [1] in- troduced a new concept trying to translate survival advantages to patients with colon cancer. This new concept of a complete mesocolic excision (CME) with a central vascular ligation (CVL) in the management of patients with colon cancer represents a kind of evolution in operative technique. The concept of a CME as a surgical technique with sharp dissection of the visceral plane from the retroperitoneal (pari- etal = somatic) one aims to avoid any breaching of the visceral fascia layer, which potentially may lead to tumor spread within the peritoneal cavity. With this procedure, the origin of the colonic arteries can be well exposed and tied centrally at their origins to ensure maximal harvesting of regional lymph nodes. CME and CVL surgery remove more tissue compared with standard surgery in terms of the distance be- tween the tumor and the highly vascular region, the length of large bowel and ileum removed, and the area of the mesentery. In addition, CME and CVL sur- gery are associated with more mesocolic plane re- sections and greater lymph node yields [2, 3]. In terms of oncologic outcomes, Hohenberger et al. [1] reported excellent cancer-specific survival rates after CME surgery (stage I, 99.1%; stage II, 91.4%; and stage III, 70.2%) [1]. Moreover, CME surgery is associated with better disease-free survival than is a conventional colon cancer resection for patients with a stage I–III colon adenocarcinoma: the 4-year dis- ease-free survivals were 85.8% after CME and 75.9%
Mohamed Ibrahim
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