Postoperative Quality Assessment Score Can Select Patients with High Risk for Locoregional Recurrence in Colon Cancer.

Mihaela Moscalu,Cristina Terinte,Dan Ferariu,Florina Adriana Ghitun,Alexandra Ramona Huluta,Gabriel Mihail Dimofte,Cristian Livadaru,Sorinel Lunca

doi:10.3390/diagnostics12020363

Abstract

Background: Monitoring surgical quality has been shown to reduce locoregional recurrence (LRR). We previously showed that the arterial stump length (ASL) after complete mesocolic excision (CME) is a reproducible quality instrument and correlates with the lymph-node (LN) yield. We hypothesized that generating an LRR prediction score by integrating the ASL would predict the risk of LRR after suboptimal surgery. Methods: 502 patients with curative resections for stage I–III colon cancer were divided in two groups (CME vs. non-CME) and compared in terms of surgical data, ASL-derived parameters, pathological parameters, LRR and LRR-free survival. A prediction score was generated to stratify patients at high risk for LRR. Results: The ASL showed significantly higher values (50.77 mm ± 28.5 mm) with LRR vs. (45.59 mm ± 28.1 mm) without LRR (p < 0.001). Kaplan–Meier survival analysis showed a significant increase in LRR-free survival at 5.58 years when CME was performed (Group A: 81%), in contrast to non-CME surgery (Group B: 67.2%). Conclusions: The prediction score placed 76.6% of patients with LRR in the high-risk category, with a strong predictive value. Patients with long vascular stumps and positive nodes could benefit from second surgery to complete the mesocolic excision.

Highlights

The principles of complete mesocolic excision (CME) for colon cancer (CC), as reinvigorated by Hohenberger [1], generated a decrease in local recurrence rate (LRR) to 3.3%
The results showed a very strong correlation between the risk categories created based on recurrence predictive factors and the patient locoregional recurrence (LRR) itself
The LRR difference alone between groups A and B would be sufficient to argue that standardized CME with constant rigorous vascular ligation ought to be the norm and best practice, to reduce the dramatically high rates of LRR derived from suboptimal surgical gestures [13]

Summary

Introduction

The principles of complete mesocolic excision (CME) for colon cancer (CC), as reinvigorated by Hohenberger [1], generated a decrease in local recurrence rate (LRR) to 3.3%. Surgical centers and countries with an interest in adopting CME with standardized systematic D2 or D3 lymphadenectomy have shown the benefits of a good surgical quality care program in reducing locoregional recurrence (LRR) [12,13,14,15]. We previously showed that the arterial stump length (ASL) after complete mesocolic excision (CME) is a reproducible quality instrument and correlates with the lymph-node (LN) yield. Methods: 502 patients with curative resections for stage I–III colon cancer were divided in two groups (CME vs non-CME) and compared in terms of surgical data, ASL-derived parameters, pathological parameters, LRR and LRR-free survival. Patients with long vascular stumps and positive nodes could benefit from second surgery to complete the mesocolic excision

Methods

Results

Discussion

Conclusion