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

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.