5-year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study
| Autor: | Anders Kirkegaard-Klitbo, Bent Kristensen, Anders Ulrich Neuenschwander, Jakob Kleif, Else Refsgaard Iversen, Leif Ahrenst Rasmussen, Peter Ingeholm, Pernille W Born, Claus Anders Bertelsen, Jens Einar Jansen, Lars V. Jepsen, Birgitte Bols, Michael Wilhelmsen, Jutaka Reilin Tenma |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Databases Factual Colorectal cancer Denmark Population Adenocarcinoma Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Humans Medicine Cumulative incidence Prospective Studies Elective surgery education Prospective cohort study Colectomy Aged Neoplasm Staging Aged 80 and over education.field_of_study business.industry Incidence medicine.disease Surgery Dissection Treatment Outcome Oncology Central Lymph Node Dissection 030220 oncology & carcinogenesis Colonic Neoplasms Female 030211 gastroenterology & hepatology Neoplasm Recurrence Local business Cohort study |
| Zdroj: | The Lancet Oncology. 20:1556-1565 |
| ISSN: | 1470-2045 |
| Popis: | Summary Background The benefits of extensive lymph node dissection as performed in complete mesocolic excision are still debated, although recent studies have shown an association with improved long-term outcomes. However, none of these studies had an intention-to-treat design or aimed to show a causal effect; therefore in this study, we aimed to estimate the causal oncological treatment effects of complete mesocolic excision on right-sided colon cancer. Methods We did a population-based cohort study involving prospective data collected from four hospitals in Denmark. We compared the oncological outcome data of patients at one centre performing central lymph node dissection and vascular division after almost complete exposure of the proximal part of the superior mesenteric vein (ie, the complete mesocolic excision group) with three other centres performing conventional resections with unstandardised and limited lymph node dissection (ie, non-complete mesocolic excision; control group). We included data for all patients in the Capital Region of Denmark undergoing elective curative-intent right-sided colon resections for stages I–III colon cancer, as categorised by the Union for International Cancer Control (UICC; 5th edition), from June 1, 2008, to Dec 31, 2013. Patients were followed-up for 5·2 years after surgery. The primary outcome was the cumulative incidence of recurrence after 5·2 years of surgery. Inverse probability of treatment weighting and competing risk analyses were used to estimate the possible causal effects of complete mesocolic excision. This study is registered with ClinicalTrials.gov , number NCT03754075 . Findings 1069 patients (813 in the control group and 256 in the complete mesocolic excision group) underwent curative-intent elective surgery for right-sided colon cancer during the study period. None of the patients were lost to follow-up regarding survival or recurrence status, and consequently no patient was censored in the analyses. The 5·2-year cumulative incidence of recurrence was 10·1% (95% CI 6·6–13·6) in the complete mesocolic excision group compared with 18·0% (15·4–20·6) in the control group, and the absolute risk reduction of complete mesocolic excision after 5·2 years was 7·9% (95% CI 3·7–12·2; p=0·00028). In the control group, 146 (18%) of 813 patients were diagnosed with a recurrence and 281 (35%) died during follow-up, whereas in the complete mesocolic excision group 26 (10%) of 256 patients were diagnosed with a recurrence and 75 (29%) died during follow-up. Interpretation This study shows a causal treatment effect of central mesocolic lymph node excision on risk of recurrence after resection for right-sided colon adenocarcinoma. Complete mesocolic excision has the potential to reduce the risk of recurrence and improve long-term outcome after resection for all UICC stages I–III of right-sided colon adenocarcinomas. Funding The Tvergaard Fund, Helen Rude Fund, Krista and Viggo Petersen Fund, Olga Bryde Nielsen Fund, and Else and Mogens Wedell-Wedellsborg Fund. |
| Databáze: | OpenAIRE |
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