Laparoscopic complete mesocolic excision with central vascular ligation in 600 right total mesocolectomies: Safety, prognostic factors and oncologic outcome

Abstract

BackgroundTo analyze our experience with laparoscopic right Mesocolectomy in right colonic cancers. Methods600 consecutive patients were studied. ResultsMortality was 0.5%; morbidity was 35.5%. Mean mesocolic area was 15339 ± 1639 mm3, specimen length 24.3 ± 3.3 cm, distance from the tumor to high tie was 103 ± 6 mm and mean lymph nodes harvested was 27 ± 3; mesocolic plane was achieved in 81% of cases. Survival was 83%; stratified survival in patients with stage II, IIIA/B and in the subgroup of stage IIIC patients with negative apical nodes was 88.7%, 72.4%, 71.4% respectively; stage IIIC patients with positive apical nodes showed poor survival (27.7%). Recurrence occurred in 177 patients (29.5%) and was mainly systemic (22.7%). At the multivariate analysis, “non mesocolic” plane of resection, positive N3 apical nodes and CEA levels >5 ng/dL were found to be independent prognostic factors. ConclusionsLaparoscopic right Mesocolectomy showed to be safe and yielded surgical specimens of high quality, with impact on survival; positive N3 apical nodes and “non mesocolic” planes were independently associated to poor outcome.