Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
N P WestP Quirke

Abstract

The plane of surgery in colonic cancer has been linked to patient outcome although the optimal extent of mesenteric resection is still unclear. Surgeons in Erlangen, Germany, routinely perform complete mesocolic excision (CME) with central vascular ligation (CVL) and report 5-year survivals of higher than 89%. We aimed to further investigate the importance of CME and CVL surgery for colonic cancer by comparison with a series of standard specimens. The fresh photographs of 49 CME and CVL specimens from Erlangen and 40 standard specimens from Leeds, United Kingdom, for primary colonic adenocarcinoma were collected. Precise tissue morphometry and grading of the plane of surgery were performed before comparison to histopathologic variables. CME and CVL surgery removed more tissue compared with standard surgery in terms of the distance between the tumor and the high vascular tie (median, 131 v 90 mm; P < .0001), the length of large bowel (median, 314 v 206 mm; P < .0001), and ileum removed (median, 83 v 63 mm; P = .003), and the area of mesentery (19,657 v 11,829 mm(2); P < .0001). In addition, CME and CVL surgery was associated with more mesocolic plane resections (92% v 40%; P < .0001) and a greater lymph node yield (median, 30 v ...Continue Reading

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Citations

Nov 26, 2010·International Journal of Colorectal Disease·Michael ThorntonPaul Rooney
Apr 25, 2014·Gastroenterology Report·Hong-Wei Yao, Yin-Hua Liu
Dec 8, 2011·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Masayuki NakashimaToshiharu Yamaguchi
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Nov 2, 2012·International Journal of Colorectal Disease·Stefano TrastulliAmilcare Parisi

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