Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study

Abstract

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.

Keywords: central vascular ligation; complete mesocolic excision; laparoscopy; minimally invasive surgery; right colon adenocarcinoma.

Fig. 1

Overall survival in stage I–IV patients treated with open and laparoscopic CME plus CVL.

Fig. 2

Overall survival in stage I–III patients treated with open and laparoscopic CME plus CVL.

Fig. 3

Overall survival in stage I–IV patients treated with open and laparoscopic CME plus CVL according to harvested lymphnodes.

Fig. 4

Operative field view of conventional CME surgery. (a) duodenum; (b) ileo‐colic vein; (c) superior mesenteric vein; (d) right colic vessels; (e) middle colic vein (its left branch); (f) inferior border of the pancreas.