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Complete mesocolic excision for right colonic cancer: prospective multicentre study.

Stefan R Benz1, Inke S Feder2, Saskia Vollmer1

  • 1Klinik für Allgemein-, Viszeral-, Thorax- und Kinderchirurgie Kliniken Boeblingen, Boeblingen, Germany.

The British Journal of Surgery
|November 12, 2022
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Summary

Complete mesocolic excision (CME) did not show a general survival benefit for right colonic cancer patients. Exploratory analysis suggested a possible survival advantage for stage III disease, but this requires further investigation.

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Clinical Trials

Background:

  • Complete mesocolic excision (CME) is a complex procedure for right colonic cancer with limited evidence for routine use.
  • The RESECTAT trial prospectively evaluated CME's effect on long-term survival in German colorectal cancer centers.
  • Primary hypothesis: CME improves 5-year disease-free survival; secondary: improved survival with larger mesenteric area excision.

Purpose of the Study:

  • To evaluate the impact of complete mesocolic excision (CME) versus standard surgery on long-term survival in right colonic cancer.
  • To determine if a larger mesenteric resection area (≥15,000 mm²) influences patient survival outcomes.

Main Methods:

  • Prospective multicenter study involving 1004 patients (496 CME, 508 no CME) across 53 centers.
  • Surgery classified as CME based on superior mesenteric vein dissection; specimens analyzed centrally.
  • Primary endpoint: 5-year overall survival for stages I-III; secondary: survival based on mesenteric area.

Main Results:

  • No significant difference in short-term or overall survival between CME and non-CME groups.
  • Anastomotic leak rates were slightly higher in the CME group (3.4%) vs. non-CME (1.8%).
  • Exploratory analysis suggested a potential overall survival benefit for CME in stage III disease (HR 0.52; P=0.010), but not for disease-free survival.

Conclusions:

  • Complete mesocolic excision (CME) did not demonstrate a general survival benefit for right colonic cancer.
  • The observed potential survival advantage in stage III disease requires further investigation due to its exploratory nature.