Is Complete Mesocolic Excision with Central Vascular Ligation Necessary for Suspected Early-stage Right-sided Colon...

Area of Science:

• Oncology
• Surgical Gastroenterology
• Colorectal Cancer Research

Background:

• Endoscopic resection is a common treatment for early-stage colon cancer.
• Complete mesocolic excision with central vascular ligation (CME-CVL) is a standard surgical approach for right-sided colon cancer.
• The necessity of CME-CVL after endoscopic resection for early-stage right-sided colon cancer requires further evaluation.

Purpose of the Study:

• To assess lymph node status in patients after endoscopic resection for early-stage right-sided colon cancer.
• To determine the need for CME-CVL in these patients.
• To evaluate the risk of lymph node metastasis in peritumoral, pericolic, and superior mesenteric regions.

Main Methods:

• Retrospective study of 119 patients undergoing additional surgery post-endoscopic intervention (May 2003 - March 2022).
• Analysis of lymph node metastasis rates and locations.
• Assessment of recurrence-free survival.

Main Results:

• 5% (Tis), 89.1% (T1), and 6.7% (T2) of patients had tumors requiring surgery.
• 10.1% of patients had lymph node metastasis (N1), all in peritumoral and pericolic regions.
• No superior mesenteric lymph node metastases were found; recurrence-free survival was 99.2% over 48.2 months.

Conclusions:

• Superior mesenteric lymph node metastasis is rare in early-stage right-sided colon cancer after endoscopic resection.
• D2 lymph node dissection may be adequate, questioning the routine use of CME-CVL in this patient group.
• CME-CVL might be reconsidered for selected patients initially treated with endoscopic resection.