Abstract
Laparoscopic colectomy procedures and their corresponding difficulty levels may vary depending on the tumor location within the colon, and a laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) would require more proficiency than a conventional laparoscopic colectomy. We aimed to report our laparoscopic CME with CVL data and to investigate the clinical outcome differences of laparoscopic CME with CVL by various tumor sub-site locations. Prospectively collected clinical data of consecutive patients who received laparoscopic colectomy for primary colon cancer between April 1995 and December 2010 from single surgeon were retrospectively reviewed. All of the included surgery was performed on the basis of CME with CVL principle with no-touch isolation technique. Data were analyzed and compared among three groups; patients who received right or extended right hemicolectomy (group A, n = 142), transverse colectomy or left or extended left hemicolectomy (group B, n = 59), and sigmoidectomy or anterior resection (group C, n = 210). Female patients were more common in group A (53.5% vs. 37.3% vs. 39.5%, p = 0.020). Other baseline characteristics were comparable. Operative time was shorter in group C than the other groups (309.0 ± 74.7 vs. 324.3 ± 89.1 vs. 280.1 ± 93.1 min, p = 0.000). There was no significant difference among groups in perioperative complication and patient recovery. Five-year overall survival, disease-free survival and local recurrence rate showed no difference for a median follow up period of 73 (1–120) months. In conclusion, laparoscopic tumor-specific CME and CVL for colon cancer can be performed with comparable short- and long-term outcomes regardless of tumor sub-site location except for the operative time.
Highlights
Studies [1, 2] that have assessed complete mesocolic excision (CME) with central vascular ligation (CVL) in colon cancer surgery have reported better oncological outcomes compared to those of conventional surgery
Laparoscopic colectomy procedures and their corresponding difficulty levels may vary depending on the tumor location within the colon, and a laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) would require more proficiency than a conventional laparoscopic colectomy
We aimed to report our laparoscopic CME with CVL data and to investigate the clinical outcome differences of laparoscopic CME with CVL by various tumor sub-site locations
Summary
Studies [1, 2] that have assessed complete mesocolic excision (CME) with central vascular ligation (CVL) in colon cancer surgery have reported better oncological outcomes compared to those of conventional surgery. Previous articles regarding CME with CVL were mostly limited to open surgeries Whether this principle can be maintained in laparoscopic surgery has not been fully determined. Complication rates may increase in a difficult procedure, and the survival outcome may be impacted if an operation is conducted against the principle to avoid surgical difficulties. For this reason, when the concept of CME with CVL was not established, most studies comparing laparoscopic and open colorectal surgery excluded transverse and descending colon cancer, which are known to be difficult for the performance of laparoscopic surgery. CME with CVL has been accepted as a standard principle in colon cancer surgery, there are few data about whether laparoscopic CME with CVL is feasible for all lesions in the colon, or about its short- and long-term outcomes
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