Laparoscopic complete mesocolic excision with central vascular ligation in 600 right total mesocolectomies: Safety, prognostic factors and oncologic outcome - 26/07/17
, Andrea Lucchi, Pierluigi Berti, Gianluca GarulliAbstract |
Background |
To analyze our experience with laparoscopic right Mesocolectomy in right colonic cancers.
Methods |
600 consecutive patients were studied.
Results |
Mortality was 0.5%; morbidity was 35.5%. Mean mesocolic area was 15339 ± 1639 mm3, specimen length 24.3 ± 3.3 cm, distance from the tumor to high tie was 103 ± 6 mm and mean lymph nodes harvested was 27 ± 3; mesocolic plane was achieved in 81% of cases. Survival was 83%; stratified survival in patients with stage II, IIIA/B and in the subgroup of stage IIIC patients with negative apical nodes was 88.7%, 72.4%, 71.4% respectively; stage IIIC patients with positive apical nodes showed poor survival (27.7%). Recurrence occurred in 177 patients (29.5%) and was mainly systemic (22.7%). At the multivariate analysis, “non mesocolic” plane of resection, positive N3 apical nodes and CEA levels >5 ng/dL were found to be independent prognostic factors.
Conclusions |
Laparoscopic right Mesocolectomy showed to be safe and yielded surgical specimens of high quality, with impact on survival; positive N3 apical nodes and “non mesocolic” planes were independently associated to poor outcome.
Le texte complet de cet article est disponible en PDF.Highlights |
• | To analyze laparoscopic total right Mesocolectomy. |
• | Overall, disease free and disease specific survival were 83%, 78.3% and 79.5% respectively. |
• | Laparoscopic Mesocolectomy showed to be safe, with significant impact on survival. |
Keywords : Right sided colonic cancer, Complete mesocolic excision, Central vascular ligation, Oncologic outcome, Quality of surgical specimen, Safety
Plan
Vol 214 - N° 2
P. 222-227 - août 2017 Retour au numéro
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