Complete mesocolic excision for right colon cancer: Is D3 lymphadenectomy necessary?

Adjuvant Chemotherapy Does Not Compensate for an Inadequate Right Colon Cancer Surgery: High Peritoneal Recurrence Rates Indicate Need for Altered Treatment Paradigms

There is a lack of evidence for optimal management of patients with right colon cancers upon referral to the oncology care centre, following an inadequate index surgery elsewhere. A prospectively maintained database of patients with right colon cancers managed between 2013 and 2019 was screened to identify those patients who underwent index surgery in a non-oncological setup. They were managed with adjuvant chemotherapy followed by observation, with surgery being reserved for recurrent disease. Of the 155 patients identified after the screening, 97 were included in the study. They were stratified depending upon the number of lymph nodes harvested at primary surgery-Group A (less than 12 nodes) (n = 49), Group B (12 to 27 nodes) (n = 39) and Group C (28 and more nodes) (n = 9). Patients with lymph node metastases had inferior survival at 2 years than node-negative patients and this survival difference increased progressively from Group A towards Group C. Patients who had radiological locoregional residual disease upon restaging (at presentation) had significantly inferior survival. At the end of 2 years, overall survival and disease-free survival of the cohort were 71.5% and 45.8%, respectively. Fifty-eight patients had disease relapse, with peritoneal recurrence seen in 37 patients (63.8%). Of these, only 15.5% recurrences were surgically salvageable. Treatment of patients who have undergone inadequate index colectomy with chemotherapy alone has shown inferior survival outcomes with high rates of peritoneal relapse in comparison to historical cohorts. The treatment strategy for such patients needs to be revisited in a prospective study design.

Comparison between laparoscopic complete mesocolic excision and D2 radical operation in colon carcinoma resection: A propensity score matching analysis

BACKGROUND

Surgery remains the most effective treatment for colon cancer. However, there are still controversies regarding the tumor treatment effect, prognosis, and perioperative impact of complete mesocolic excision (CME) surgery in colon carcinoma resection.

OBJECTIVE

This study aims to compare laparoscopic complete mesocolic excision (LCME) and traditional open D2 radical surgery in colon carcinoma resection through a retrospective analysis using 1:1 propensity score matching (PSM).

METHODS

98 cases undergoing LCME or open D2 colon carcinoma resection at our hospital from January 2014 to November 2021 were retrospectively collected. After excluding cases and 1:1 matching using PSM based on baseline clinical data, 86 patients were assigned in research queue. 43 patients were in each group. Two groups were compared for general clinical baseline indicators. Surgical results and postoperative adverse events of patients were also compared. Disease-free survival (DFS) rate and overall survival (OS) rate was analyzed.

RESULTS

After 1:1 PSM matching, there was no statistically significant differences in baseline data between the LCME group and D2 group (P> 0.05). LCME was characterized by longer total duration of surgery (P< 0.001), less intraoperative bleeding volume (P< 0.001), more postoperative drainage fluid volume (P< 0.001), greater number of lymph nodes retrieved (P= 0.014). No statistically differences was observed regarding intraoperative blood transfusion, hospital stay, Clavien-Dindo complicating disease classification (all P> 0.05), 1 and 3-year DFS rate (P= 0.84) and OS rate (P⩾ 0.1).

CONCLUSION

LCME had a longer duration of surgery but less intraoperative bleeding volume and more postoperative drainage fluid volume and retrieved lymph nodes compared to D2 radical surgery. LCME surgery is comparable to D2 surgery in terms of postoperative prognosis, but LCME surgery shows a positive trend in the overall survival curve.

Tata Memorial Centre Evidence Based Management of Colorectal cancer

This review article examines the evidence-based management of colorectal cancers, focusing on topics characterized by ongoing debates and evolving evidence. To contribute to the scientific discourse, we intentionally exclude subjects with established guidelines, concentrating instead on areas where the current understanding is dynamic. Our analysis encompasses a thorough exploration of critical themes, including the evidence surrounding complete mesocolic excision and D3 lymphadenectomy in colon cancers. Additionally, we delve into the evolving landscape of perioperative chemotherapy in both colon and rectal cancers, considering its nuanced role in the context of contemporary treatment strategies. Advancements in surgical techniques are a pivotal aspect of our discussion, with an emphasis on the utilization of minimally invasive approaches such as laparoscopy and robotic surgery in both colon and rectal cancers, including advanced rectal cases. Moving beyond conventional radical procedures, we scrutinize the feasibility and implications of endoscopic resections for small tumors, explore the paradigm of organ preservation in locally advanced rectal cancers, and assess the utility of total neoadjuvant therapy in the current treatment landscape. Our final segment reviews pivotal trials that have significantly influenced the management of colorectal liver and peritoneal metastasis.