Comparison of outcomes of complete mesocolic excision with conventional radical resection performed by laparoscopic approach for right colon cancer

Figures & data

Figure 1 Surgical planes in laparoscopic CME for ascending colon cancer.

Abbreviations: ARF, anterior renal fascial plane; FSP, first surgical plane; SMA, superior mesenteric artery; SMV, superior mesenteric vein; SSP, second surgical plane; CME, complete mesocolic excision.

Figure 2 Central lymph node group (N3; 203, 213, and 223) excision and the left side of SMA incisal margin in the laparoscopic CME group, for hepatic flexure colon cancer.

Abbreviations: TSP, third surgical plane; SMA, superior mesenteric artery; SMV, superior mesenteric vein; SSP, second surgical plane; CME, complete mesocolic excision.

Figure 3 Right side of SMV incisal margin in laparoscopic CRR for right-sided colon cancer.

Abbreviations: SMV, superior mesenteric vein; CRR, conventional radical resection.

Table 1 Clinical characteristics and surgical data of the CME and CRR (control) groups

		CME	CRR	P
Subjects, n		107	60
Gender, n (%)	Male	62 (57.6)	34 (56.7)	0.872
	Female	45 (42.4)	26 (43.3)
Age, y		57.6±9.1	58.3±9.3	0.671
BMI, kg/m^2		23.5±3.9	23.5±4.2	0.847
Tumor size, cm		4.9±1.0	4.8±1.0	0.568
Tumor to HVT, cm		12.6±1.3	11.5±1.1	<0.001
Closest bowel wall to HVT, cm		10.4±0.9	9.3±1.0	<0.001
Length of the resected bowel		25.8±0.7	25.5±2.1	0.106
pTNM, n (%)	I	15 (14.0)	10 (16.7)	0.872
	II	59 (55.1)	31 (51.7)
	III	33 (30.9)	19 (31.6)

Figure 4 Specimen of ascending colon cancer in laparoscopic CME. The distance between the tumor and HVT is ~13 cm.

Table 2 Lymph nodes harvested in the CME and CRR groups, n

		CME	CRR	P
Subjects		107	60
Lymph nodes harvested	Stage I	16.7±3.9	13.8±3.2	<0.001
	Stage II	21.4±5.1	13.9±3.7	<0.001
	Stage III	24.8±5.4	16.2±4.1	<0.001
Stage III lymph nodes	Positive (%)	0.17±0.08	0.18±0.08	0.473
Negative lymph nodes	Stage III	20.6±4.6	13.2±3.5	<0.001

Table 3 Operative outcomes in the CME and control groups

		CME	CRR	P
Operative time, min		192.4±31.4	187.1±33.1	0.306
Intraoperative blood loss,mL,		108.4±23.9	128.7±25.2	<0.001
First flatus, d		2.9±1.4	3.1±1.3	0.472
First stool, d		3.8±1.1	4.1±1.0	0.066
Postoperative hospital stay, d		6.44±2.1	7.29±2.9	0.077
Complications	Overall	13 (12.1%)	10 (16.7%)	0.278
	Intestinal obstruction	5 (4.7%)	2 (3.3%)	0.510
	Wound infection	3 (2.8%)	2 (3.3%)	0.592
	Fat liquefaction of wound	2 (1.9%)	1 (1.7%)	0.707
	Anastomotic leakage	1 (0.9%)	3 (5.0%)	0.133
	Pulmonary infection	1 (0.9%)	1 (1.7%)	0.519
	Urinary tract infection	1 (0.9%)	1 (1.7%)	0.519

Figure 5 Kaplan Meier curves representing disease-free survival and overall survival of the 2 groups.