Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II

Abstract

The aim of the present study was to investigate whether the new method of complete mesocolic excision (CME) with a high (apical) vascular tie (D3 resection) had an immediate effect compared with a conventional (standard) approach even in those patients without lymph node metastases. A cohort of 189 consecutive patients with tumour-nodal-metastasis (TNM) stages I-II and a mean age of 73years were operated on in the period from January 2007 to December 2008 in three community teaching hospitals. The CME approach (n=89), used in hospital A, was compared to the standard technique used (n=105) in two other hospitals, B and C. Lymph node yields from the specimens were used as a surrogate measure of radical resections. Outcome was analysed after a median follow-up of 50.2months. In-hospital mortality rate was 2.8% in the CME group and 8.6% in the standard group. The 3-year overall survival (OS) in the CME group was 88.1 versus 79.0% (p=0.003) in the standard group, and the corresponding disease-free survival (DFS) was 82.1 versus 74.3% (p=0.026). Cancer-specific survival was 95.2% in the CME group versus 90.5% in the standard group (p=0.067). Age, operative technique, and T category were significant in multiple Cox regressions of OS and DFS. Compared with the standard (D2) approach, introduction of CME surgical management of colon cancer resulted in a significant immediate improvement of 3-year survival for patients with TNM stage I-II tumours as assessed by OS and DFS.