Total mesocolic excision versus traditional resection in right-sided colon cancer - method and increased lymph node harvest

Abstract

Introduction: Rectal surgery has followed a steady trend towards improved surgical techniques over the past 15 years. Danish colon cancer surgery has not witnessed similar progress. Hohenberger described a comprehensive method involving complete excision of all mesocolic tissue which is equivalent to right-sided hemicolectomy. The present work describes the difference between the traditional surgical method and the comprehensive method, and provides detail on the outcome in 11 patients with regard to morbidity, mortality and lymph node status.

Material and methods: Eleven cases with tumours located orally to the right flexure were included in the study. Surgery was performed using the comprehensive method. After excision of the specimen, the surgeon determined and marked-up the extra central part of the mesentery which had been excised. A pathologist examined the specimen. The extra mesentery segment was independently examined, described and embedded for microscopy, mortality rate, major adverse cardiovascular events, symptom relief and quality-of-life at six-month follow-up.

Results: Lymph nodes were found in the extra segment of all specimens, and in two patients the extra segment contained malignant lymph nodes. We found twelve or more lymph nodes in all specimens. Without the extra specimen segment, this would not have been possible in five of the patients.

Conclusion: Our finding of centrally located lymph nodes confirms Hohenberger's claim that the probability of successful macro-radical removal increases with the removal of such lymph nodes, and removal of as many lymph nodes as possible should generally be considered beneficial to the patient.