Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors

Abstract

OBJECTIVE: To investigate the long-term oncologic outcomes and risk factors for adverse effects in right-sided colon cancer patients who underwent modified complete mesocolic excision (mCME).

BACKGROUND: Complete mesocolic excision (CME) with central vascular ligation has recently been found to improve oncological outcomes in patients with colon cancer. Our institution has established mCME on the basis of the original concept of CME for the treatment of right-sided colon cancer.

METHODS: Between January 2000 and July 2009, 773 patients who underwent mCME for right-sided colon cancer were eligible for this retrospective study. The prognostic factors for survival/recurrence and the risk factors for postoperative complications were investigated.

RESULTS: The mean follow-up period was 61.9 ± 34.7 months. The 5-year overall survival and 5-year disease-free survival rates were 84.0% and 82.8%, respectively. Pathologic stage III disease, postoperative complications, age more than 60 years, and minimally invasive surgery were found to be independent prognostic factors. The 5-year locoregional recurrence (LRR) and 5-year systemic recurrence rates (SRRs) were 4.9% and 13.7%, respectively. The risk of LRR and SRR increased with pathologic stage III disease. An American Society of Anesthesiology score of higher than II was an independent predictive factor of postoperative complications.

CONCLUSIONS: We have successfully established the mCME technique, on the basis of the same principle as CME, but with a more tailored approach. The long-term oncologic outcomes and risk of postoperative morbidity were found to be comparable with those seen with the original CME procedure.