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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

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Abstract

Background

The aim of the present study was to investigate whether the new method of complete mesocolic excision (CME) with a high (apical) vascular tie (D3 resection) had an immediate effect compared with a conventional (standard) approach even in those patients without lymph node metastases.

Methods

A cohort of 189 consecutive patients with tumour–nodal–metastasis (TNM) stages I–II and a mean age of 73 years were operated on in the period from January 2007 to December 2008 in three community teaching hospitals. The CME approach (n = 89), used in hospital A, was compared to the standard technique used (n = 105) in two other hospitals, B and C. Lymph node yields from the specimens were used as a surrogate measure of radical resections. Outcome was analysed after a median follow-up of 50.2 months.

Results

In-hospital mortality rate was 2.8 % in the CME group and 8.6 % in the standard group. The 3-year overall survival (OS) in the CME group was 88.1 versus 79.0 % (p = 0.003) in the standard group, and the corresponding disease-free survival (DFS) was 82.1 versus 74.3 % (p = 0.026). Cancer-specific survival was 95.2 % in the CME group versus 90.5 % in the standard group (p = 0.067). Age, operative technique, and T category were significant in multiple Cox regressions of OS and DFS.

Conclusions

Compared with the standard (D2) approach, introduction of CME surgical management of colon cancer resulted in a significant immediate improvement of 3-year survival for patients with TNM stage I–II tumours as assessed by OS and DFS.

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Acknowledgments

Grants were obtained from the Western Norway Regional Health Authority, the University of Bergen, and Haraldsplass Deaconess Hospital. The Departments of Pathology contributed with routine specimen examinations.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Surgery, Haraldsplass Deaconess Hospital, University of Bergen, POB 6165, 5892, Bergen, Norway

    K. E. Storli, K. Søndenaa & B. Furnes

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    K. Søndenaa

  3. Department of Surgery, Stavanger University Hospital, Stavanger, Norway

    I. Nesvik

  4. Department of Pathology, Stavanger University Hospital, Stavanger, Norway

    E. Gudlaugsson

  5. Department of Surgery, Akershus University Hospital, Oslo, Norway

    I. Bukholm

  6. Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway

    G. E. Eide

  7. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

    G. E. Eide

Authors
  1. K. E. Storli
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  2. K. Søndenaa
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  3. B. Furnes
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  4. I. Nesvik
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  5. E. Gudlaugsson
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  6. I. Bukholm
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  7. G. E. Eide
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Corresponding author

Correspondence to K. Søndenaa.

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Storli, K.E., Søndenaa, K., Furnes, B. et al. 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, 557–564 (2014). https://doi.org/10.1007/s10151-013-1100-1

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  • DOI: https://doi.org/10.1007/s10151-013-1100-1

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