Propensity score-matched comparison between complete mesocolic excision and classic right hemicolectomy for colon cancer.

ABSTRACT

BACKGROUND: The prognosis of right colon cancer remains disappointing. Complete mesocolic excision (CME) with central vascular ligation (CVL), based on the same oncological principles of total mesorectal excision, has been speculated to result in a better outcome. To evaluate the oncological adequacy of CME with CVL, we carried out a comparative study with propensity score-matched analysis between two different surgical procedures performed at Italian and Egyptian University cancer centers. METHODS: Forty-six Egyptian patients underwent conventional right hemicolectomy, while eighty-eight Italian patients underwent CME with sharp dissection between the embryological planes, exposure of the superior mesenteric vessels with extended lymphadenectomy, and CVL. RESULTS: All operations were successful with no increase in postoperative complications (10% in the patients undergoing CME vs. 19.5% in Egyptian patients). Number of harvested nodes (21 vs. 13) and lymph node ratio (0.08 vs. 0.22) were significantly different in patients undergoing CME (P=0.0001 and P=0.005, respectively). In these patients, the risk of cancer relapse was reduced to as much as one third (8% vs. 22%), even in node-positive tumors, and locoregional recurrences were never experienced. The classic operation was significantly associated with poor outcome (5-year disease-free survival rates were 89.2% in the group undergoing CME and 49.1% in the classic group, P=0.02). Propensity score-matched analysis warranted optimal balance and confirmed overall results. CONCLUSIONS: Right colon cancer patients undergoing CME benefitted from more oncological adequacy, with no increased postoperative complication rate, a decreased locoregional recurrence rate, and a better long-term outcome than patients operated on with the conventional procedure.