Mesenteric Recurrence of Colon Cancer: Evidence for the Use of Oncologic Complete Mesocolic Excision

Abstract

INTRODUCTION: The principles surrounding complete mesocolic excision (CME) of colon cancer are 1) careful dissection between the mesenteric plane and parietal fascia, 2) removal of the complete mesentery with encasement of the mesenteric fascia and visceral peritoneum and 3) high/central vascular ligation. All mesenteric lymph nodes draining the tumor centrally should be excised. CME has been associated with a decreased rate of colon cancer recurrence but is somewhat controversial. We present a consecutive series of patients referred to our institution with recurrent colon cancer and evidence of a previous, non-CME colon cancer resection. METHODS: Patients were prospectively identified from Tumor Board discussions between 11/2018 and 02/2022. All had mesenteric/nodal recurrence and evidence of residual mesentery and/or vascular supply of after previous operation. RESULTS: Eleven patients (8/73% male, mean age 64.8 ± 16.9 years) were included. The primary tumor was located in the ascending colon (n=5), sigmoid/descending colon (n=4), transverse colon (n=1) and caecum (n=1). Nine recurrences (82%) were in the mesentery only and 2 were in the colon/anastomosis and mesentery. Time from primary operation to identification of mesenteric cancer recurrence was 2 months-4.9 years. Eight (73%) underwent chemotherapy after primary resection (7 with 5 FU based). Seven (64%) patients underwent a subsequent resection based on CME principles. CONCLUSION: We describe a cohort of patients with a mesenteric colon cancer recurrence after a radiologically confirmed, non-CME resection. The majority had chemotherapy after their index resection. A total of 37% were not amenable to a subsequent salvage CME-based resection.