Optimizing colonic cancer surgery: high ligation and complete mesocolic excision during right hemicolectomy

Abstract

When performing a colonic resection for cancerous lesions, a complete mesocolic excision (CME) can lead to improved oncologic results. The CME along with the high vessel ligation, meaning the ligation of the supplying vessels close to their origin, can ensure maximal lymph node harvest. The principles of CME and high ligation have been applied by us during colonic resections for cancer. We present our experience with tumors of the proximal colon, for which a radical right hemicolectomy has been performed. Between 1989 and 2008, we performed a right hemicolectomy in 115 patients. The mean age was 65.6 years (range 35-86). The tumor was located in the cecum in 37% of patients, the ascending colon in 58% of the patients and the hepatic flexure in 5% of the patients. All patients underwent complete mesocolic excision and high ligation of the supplying vessels. A total of 93% (107/115) of these operations were performed on an elective basis. Out of all patients, 48 (42%) received adjuvant chemotherapy. No patient died during the immediate postoperative period. The postoperative morbidity was 13.9% (16/115). One patient developed a metachronous rectal carcinoma 28 months after his surgery, for which he underwent an abdoperineal resection. The 5-year survival rate lies at 72.4% (55/76). Twenty patients (26.3%) died due to metastatic disease before completing 5 years of follow-up. The remaining 39 patients have been operated after the end of 2004 and have therefore not completed 5 years from the day of their operation yet. There is no doubt that standardized oncologic surgery shows particular importance by reducing the rate of local recurrence and achieving increased survival. It is important to remember that colon cancer treatment today is multimodal and that the improvement in patients' survival in the last decades is surely linked with the improvement in chemotherapy and the advances in the agents used. However, optimal surgery is with no doubt an important element of good oncological outcome, as the experience with rectal cancer treatment has taught us.