scholarly journals Complete mesocolic excision and central vascular ligation for right colon cancer: an introduction for abdominal radiologists

2019 ◽  
Vol 44 (11) ◽  
pp. 3518-3526
Author(s):  
David D. B. Bates ◽  
Viktoriya Paroder ◽  
Chandana Lall ◽  
Neeraj Lalwani ◽  
Maria Widmar ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Complete Mesocolic Excision ◽  
Right Colon ◽  
Central Vascular Ligation ◽  
Right Colon Cancer ◽  
Vascular Ligation ◽  
Mesocolic Excision

scholarly journals Robotic Complete Mesocolic Excision with Central Vascular Ligation for Right Colon Cancer: Surgical Technique and Short-term Outcomes

2020 ◽  
Vol 11 (4) ◽  
pp. 674-683
Author(s):  
C. Ramachandra ◽  
Pavan Sugoor ◽  
Uday Karjol ◽  
Ravi Arjunan ◽  
Syed Altaf ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Open Surgery ◽  
Complete Mesocolic Excision ◽  
Right Colon ◽  
Short Term ◽  
Central Vascular Ligation ◽  
Oncological Outcomes ◽  
Right Colon Cancer ◽  
Vascular Ligation ◽  
Mesocolic Excision

Abstract Background Minimally invasive colorectal surgery has demonstrated to have the same oncological results as open surgery, with better clinical outcomes. Robotic assistance is an evolution of minimally invasive technique. Purpose The study aims to present technical details and short-term oncological outcomes of robotic-assisted complete mesocolic excision (CME) with central vascular ligation (CVL) for right colon cancer. Methodology Fifty-two consecutive patients affected by right colon cancer were operated between May 2016 and February 2020 with da Vinci Xi platform. Data regarding surgical and short-term oncological outcomes were systematically collected in a colorectal specific database for statistical analysis. Results Thirty-seven (71.15%) and 15 (28.85%) patients underwent right and extended right hemicoletomy with an extracorporeal anastomosis. Median age was 55 years. Mean operative time was 182 ± 36 min. Mean blood loss was 110 ± 90 ml. Conversion rate was 3.84% (two cases). 78.84% (41 cases) were pT3 and mean number of harvested lymph nodes was 28 ± 4. 1/52 (1.92%) had a documented anastomotic leak requiring exploratory laparotomy and diversion proximal ileostomy. Surgery-related grade IIIa–IIIb Calvien Dindo morbidity were noted in 9.61% and 1.92%, respectively. Conclusion Robotic assistance allows performance of oncological adequate dissection of the right colon with radical lymphadenectomy as in open surgery, confirming the safety and oncological adequacy of this technique, with acceptable results and short-term outcomes.

scholarly journals Laparoscopic versus open complete mesocolic excision with central vascular ligation in right colon cancer

2019 ◽  
Vol 6 (5) ◽  
pp. 1566
Author(s):  
Hossam Abdelkader El-Fol ◽  
Mohamed Sabry Ammar ◽  
Tamer Fakhry Abdelaziz ◽  
Mohammed A. Elbalshy ◽  
Mahmoud M. Elabassy
Keyword(s):  
Colon Cancer ◽  
Complete Mesocolic Excision ◽  
Tumor Location ◽  
Demographic Variables ◽  
Sex Distribution ◽  
Right Colon ◽  
Central Vascular Ligation ◽  
Vascular Ligation ◽  
Mesocolic Excision ◽  
Age And Sex

Background: The purpose of this study was to compare between laparoscopic and open complete mesocolic excision (CME) with central vascular ligation (CVL) in right colon cancer.Methods: From January 2016 to December 2018, a prospective cohort study of 60 patients who diagnosed as operable right sided colon cancer was performed. The patients were classified into laparoscopic CME with CVL and open CME with CVL groups. Demographic variables, comorbidities, tumor location, intraoperative parameters, duration of hospital study, histopathological findings, postoperative complications and follow up data were compared between the two groups. Demographic variables included age and sex distribution. Intraoperative parameters included incision length, operative time and operative blood loss.Results: 60 patients were selected in this study. Both groups were the same in the age and sex distribution, potential comorbidities and tumor location. Patients in the Laparoscopic CME with CVL group had shorter incision lengths, longer operative times, less operative blood loss, shorter hospital stay, less number of retrieved  lymph nodes , the same TNM (tumor nodes metastasis) classifications, similar histopathological findings and comparable incidence of postoperative complications.Conclusions: Laparoscopic CME with CVL procedure is a safe, valid and feasible surgical method for right colon cancers.

Minimally invasive complete mesocolic excision and central vascular ligation for right colon cancer: Defining the radicality of central lymphadenectomy.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 715-715
Author(s):  
Tarik Sammour ◽  
Songphol Malakorn ◽  
Rajesh Thampy ◽  
Harmeet Kaur ◽  
Brian Bednarski ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Complete Mesocolic Excision ◽  
High Ligation ◽  
D2 Lymphadenectomy ◽  
Right Colon ◽  
Central Vascular Ligation ◽  
D3 Lymphadenectomy ◽  
Right Colon Cancer ◽  
Vascular Ligation ◽  
Mesocolic Excision

715 Background: Complete mesocolic excision (CME) with central vascular ligation (CVL) has been advocated for right colon cancer (RC), but the radicality of lymphadenectomy remains controversial. Optimal D2 lymphadenectomy removes all intermediate nodes with high ligation (HL) of feeding vessels, while D3 lymphadenectomy additionally exposes and retrieves nodes along ventral superior mesenteric vessels (SMA/V). We aim to evaluate minimally invasive CME-CVL, explicitly defining the radicality of central lymphadenectomy. Methods: Patients who underwent minimally invasive resection for RC between 2008 and 2016 were identified from a prospective institutional database. CME was standard. The radicality of central lymphadenectomy was defined as high ligation (HL, optimal D2) vs central node dissection (CND, D3) after review of operative reports and/or videos. A blinded radiologist evaluated the pre- and post-operative CT scans for radiographically abnormal nodes. Results: Among 200 patients, 169 (84.5%) underwent laparoscopic and 31 (15.5%) robotic resection. Central lymphadenectomy was performed as HL in 58 (29%) and as CND in 142 (71%) patients. Preoperative imaging identified abnormal D2 nodes in 33.0% and D3 nodes in 2.6%. CND was performed in 73% of those with abnormal D2 and 100% of those with abnormal D3 nodes. Pathologically positive nodes were identified in 41% (37.9% of the HL and 42.3% of the CND, p=0.64). The median number of nodes retrieved was 27 and 32, respectively. No patient had residual abnormal node on post-operative imaging. The 30 day mortality rate was 0%, and morbidity rate was 15% (4% grade 3, 11% grades 1-2). After a median of 22 months, one (0.5%) patient recurred locally at the anastomosis. Conclusions: Minimally invasive CME-CVL can be safely performed with excellent nodal yield with both optimal D2 as well as D3 lymphadenectomy. With imperfect clinical nodal staging, the near-zero local recurrence rate observed supports CME with optimal D2 lymphadenectomy as a minimum standard and D3 lymphadenectomy when radiographically abnormal nodes are identified.

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