Top

Published in:

Open Access 01-02-2021 | Colectomy | Original Article

Laparoscopic Colectomy vs Laparoscopic CME: a Retrospective Study of Two Hospitals with Comparable Laparoscopic Experience

Authors: Juha KA Rinne, Anu Ehrlich, Jaana Ward, Ville Väyrynen, Mikael Laine, Ilmo H Kellokumpu, Matti Kairaluoma, Marja K Hyöty, Jyrki AO Kössi

Published in: Journal of Gastrointestinal Surgery | Issue 2/2021

Abstract

Purpose

To compare laparoscopic non-CME colectomy with laparoscopic CME colectomy in two hospitals with similar experience in laparoscopic colorectal surgery.

Methods

Data was collected retrospectively from Päijät-Häme Central Hospital (PHCH, NCME group) and Central Finland Central Hospital (CFCH, CME group) records. Elective laparoscopic resections performed during 2007–2016 for UICC stage I–III adenocarcinoma were included to assess differences in short-term outcome and survival.

Results

There were 340 patients in the NCME group and 325 patients in the CME group. CME delivered longer specimens (p < 0.001), wider resection margins (p < 0.001), and more lymph nodes (p < 0.001) but did not result in better 5-year overall or cancer-specific survival (NCME 77.9% vs CME 72.9%, p = 0.528, NCME 93.2% vs CME 88.9%, p = 0.132, respectively). Thirty-day morbidity, mortality, and length of hospital stay were similar between the groups. Conversion to open surgery was associated with decreased survival.

Discussion

Complete mesocolic excision (CME) is reported to improve survival. Most previous studies have compared open CME with open non-CME (NCME) or open CME with laparoscopic CME. NCME populations have been historical or heterogeneous, potentially causing bias in the interpretation of results. Studies comparing laparoscopic CME with laparoscopic NCME are few and involve only small numbers of patients. In this study, diligently performed laparoscopic non-CME D2 resection delivered disease-free survival results comparable with laparoscopic CME but was not safer.

Forman D, Ferlay J “Chapter 1.1: The global and regional burden of cancer”. In Stewart BW, Wild CP. World Cancer Report. 2014 the International Agency for Research on Cancer, World Health Organization. pp. 16–53. ISBN 978-92-832-0443-5

Fitzmaurice C, Allen C, Barber RM et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2017;3(4):524–548. doi:https://doi.org/10.1001/jamaoncol.2016.5688CrossRefPubMed

Enker WE, Laffer UT, Block GE (1979) Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 190:350–357CrossRef

Bokey EL, Chapuis PH, Dent OF, Mander BJ, Bissett IP, Newland RC (2003) Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon Rectum 46(7):860–866. doi:https://doi.org/10.1097/01.DCR.0000074731.78773.BB.CrossRefPubMed

West NP, Morris EJA, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9(9):857–865. doi:https://doi.org/10.1016/S1470-2045(08)70181-5.CrossRefPubMed

Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Color Dis 11(4), 354–355. https://doi.org/10.1111/j.1463-1318.2008.01735.x.CrossRef

Merkel S, Weber K, Matzel KE, Agaimy A, Gohl J, & Hohenberger W (2016) Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision. Br J Surg 103(9), 1220–1229. https://doi.org/10.1002/bjs.10183.CrossRefPubMed

West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30(15):1763–1769. doi:https://doi.org/10.1200/JCO.2011.38.3992.CrossRefPubMed

Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Neuenschwander AU, Vilandt J (2011) Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Color Dis 13(10):1123–9. doi: https://doi.org/10.1111/j.1463-1318.2010.02474.x,CrossRef

10.

Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Gogenur I (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. The Lancet Oncology 16(2), 161–168. https://doi.org/10.1016/S1470-2045(14)71168-4.CrossRefPubMed

11.

Siani LM, Garulli G (2016) Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: A comprehensive review. World J Gastrointest Surg 8(2):106–114. doi:https://doi.org/10.4240/wjgs.v8.i2.106.CrossRefPubMedPubMedCentral

12.

Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, Yin M, Yang X, Wang S, Ye Y (2017) Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Color Dis 19(11):962–972. doi:https://doi.org/10.1111/codi.13900.CrossRef

13.

Adamina M, Manwarning LM, Park K-JP (2012) Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc 26:2976–2980.CrossRef

14.

Feng B, Sun J, Ling T-L (2012) Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: Feasibility and technical strategies. Surg Endosc 26:3669–3675.CrossRef

15.

Melich G, Jeong DH, Hur H, Baik SH, Faria J, Kim NK, Min BS (2014) Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy--analysis of learning curves for a novice minimally invasive surgeon. Can J Surg 57(5):331–336.CrossRef

16.

Ozben V, Aytac E, Atasoy D, Erenleder Bayraktar I, Bayraktar O, Sapci I, Baca B, Karahasanoglu T, Hamzaoglu I (2018) Totally robotic complete mesocolic excision for right-sided colon cancer. J Robot Surg. doi:https://doi.org/10.1007/s11701-018-0817-2.

17.

Hohenberger W, Reingruber B, Merkel S (2003) Surgery for colon cancer. Scand J Surg 92(1):45–52. doi:https://doi.org/10.1177/145749690309200107CrossRefPubMed

18.

Ehrlich A, Kairaluoma M, Böhm J, Vasala K, Kautiainen H, Kellokumpu I (2016) Laparoscopic Wide Mesocolic Excision and Central Vascular Ligation for Carcinoma of the Colon. Scand J Surg 105(4):228-234. doi: https://doi.org/10.1177/1457496915613646.CrossRefPubMed

19.

Clancy C, O’Leary DP, Burke JP, Redmond HP, Coffey JC, Kerin MJ, Myers E (2015) A meta-analysis to determine the oncological implications of conversion in laparoscopic colorectal cancer surgery. Color Dis 17(6):482–490. doi:https://doi.org/10.1111/codi.12875.CrossRef

20.

Sondenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, Brown G, Tudyka V, D’Hoore A, Kennedy RH, West NP, Kim SH, Heald R, Storli KE, Nesbakken A, Moran B (2014) The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Color Dis 29(4):419–428. doi:https://doi.org/10.1007/s00384-013-1818-2.CrossRef

21.

Alhassan N, Yang M, Wong-Chong N, Liberman AS, Charlebois P, Stein B, Fried GM, Lee L (2018) Comparison between conventional colectomy and complete mesocolic excision for colon cancer: a systematic review and pooled analysis: A review of CME versus conventional colectomies. Surg Endosc. doi:https://doi.org/10.1007/s00464-018-6419-2.

22.

Storli KE, Søndenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I, Eide GE. (2014) Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol. 18(6):557–64. doi: https://doi.org/10.1007/s10151-013-1100-1.CrossRefPubMed

23.

Killeen S, Mannion M, Devaney A, Winter DC (2014) Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Color Dis 16(8):577–594. doi:https://doi.org/10.1111/codi.12616.CrossRef

24.

Gao Z, Wang C, Cui Y, Shen Z, Jiang K, Shen D, Wang Y, Zhan S, Guo P, Yang X, Liu F, Shen K, Liang B, Yin M, Xie Q, Wang Y, Wang S, Ye Y (2018) Efficacy and Safety of Complete Mesocolic Excision in Patients With Colon Cancer: Three-year Results From a Prospective, Nonrandomized, Double-blind, Controlled Trial. Ann Surg. doi:https://doi.org/10.1097/SLA.0000000000003012.

25.

Deijen CL, Vasmel JE, de Lange-de Klerk ESM, Cuesta MA, Coene PLO, Lange JF, Meijerink WJHJ, Jakimowicz JJ, Jeekel J, Kazemier G, Janssen IMC, Påhlman L, Haglind E, Bonjer HJ; COLOR (COlon cancer Laparoscopic or Open Resection) study group (2017) Ten- Year outcomes of randomized trial of laparoscopic versus open surgery for colon cancer. Surg Endosc. 31(6):2607-2615. doi: https://doi.org/10.1007/s00464-016-5270-6.CrossRefPubMed

26.

Athanasiou CD, Markides GA, Kotb A, Jia X, Gonsalves S, Miskovic D (2016) Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Color Dis 18(7):O224–35. doi:https://doi.org/10.1111/codi.13385.CrossRef

27.

Kim IY, Kim BR, Choi EH, Kim YW (2016) Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation. Int J Surg 27:151–157. doi:https://doi.org/10.1016/j.ijsu.2016.02.001.CrossRefPubMed

28.

Strey WC, Wullstein C, Adamina M (2018) Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept. Surg Endosc 32(12):5021–5030CrossRef

29.

Tan KY, Kawamura YJ, Mizokami K, Sasaki J,Tsujinaka S, Maeda T, Nobuki M, Konishi F (2010) Distribution of the first metastatic lymph node in colon cancer and its clinical significance. Color Dis 12(1):44–47. doi:https://doi.org/10.1111/j.1463-1318.2009.01924.x.CrossRef

Title: Laparoscopic Colectomy vs Laparoscopic CME: a Retrospective Study of Two Hospitals with Comparable Laparoscopic Experience
Authors: Juha KA Rinne
Anu Ehrlich
Jaana Ward
Ville Väyrynen
Mikael Laine
Ilmo H Kellokumpu
Matti Kairaluoma
Marja K Hyöty
Jyrki AO Kössi
Publication date: 01-02-2021
Publisher: Springer US
Keywords: Colectomy
Colectomy
Published in: Journal of Gastrointestinal Surgery / Issue 2/2021
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04502-8

At a glance: The STEP trials

Springer Medicine

Laparoscopic Colectomy vs Laparoscopic CME: a Retrospective Study of Two Hospitals with Comparable Laparoscopic Experience

Abstract

Purpose

Methods

Results

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Discussion

Please log in to get access to this content

Other articles of this Issue 2/2021

Outcomes of Per-oral Endoscopic Myotomy in Sigmoid and Advanced Sigmoid Achalasia

Re-examining “Never Letting the Sun Rise or Set on a Bowel Obstruction” in the Era of Acute Care Surgery

Prognostic Nutritional Index and Systemic Immune-Inflammation Index Predict the Prognosis of Patients with HCC

Laparoscopic Central Splenectomy for Littoral Cell Angioma

The Impact of Bariatric Surgery Compared to Metformin Therapy on Pregnancy Outcomes in Patients with Polycystic Ovarian Syndrome: a Systematic Review and Meta-analysis

The Impact of Preoperative Anti-TNFα Therapy on Postoperative Outcomes Following Ileocolectomy in Crohn’s Disease