Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study
| Autor: | Giuseppe Di Martino, Federico Selvaggi, Roberto Cotellese, Lorenzo Mazzola, Domenica Carmen Testa |
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| Rok vydání: | 2021 |
| Předmět: |
Laparoscopic surgery
medicine.medical_specialty medicine.medical_treatment education Adenocarcinoma Ascending colon Medicine Humans Stage (cooking) Colonic adenocarcinoma Laparoscopy Ligation Colectomy Retrospective Studies medicine.diagnostic_test business.industry General Medicine Surgery Treatment Outcome Colonic Neoplasms Lymph Node Excision business Stage iv Laparoscopic right hemicolectomy Mesocolon |
| Zdroj: | ANZ journal of surgery. 92(1-2) |
| ISSN: | 1445-2197 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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