Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery

Background Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with ‘conventional’ surgery, but there is a potential for higher morbidity. Methods Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 20...

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Published in:	British journal of surgery Vol. 103; no. 5; pp. 581 - 589
Main Authors:	Bertelsen, C. A., Neuenschwander, A. U., Jansen, J. E., Kirkegaard-Klitbo, A., Tenma, J. R., Wilhelmsen, M., Rasmussen, L. A., Jepsen, L. V., Kristensen, B., Gögenur, I.
Format:	Journal Article
Language:	English
Published:	Chichester, UK John Wiley & Sons, Ltd 01-04-2016 Oxford University Press
Subjects:	Adenocarcinoma - mortality Adenocarcinoma - surgery Aged Aged, 80 and over Colectomy - methods Colonic Neoplasms - mortality Colonic Neoplasms - surgery Databases, Factual Female Humans Laparoscopy Logistic Models Male Mesocolon - surgery Middle Aged Postoperative Complications - etiology Propensity Score Retrospective Studies Treatment Outcome
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Summary:	Background Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with ‘conventional’ surgery, but there is a potential for higher morbidity. Methods Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study). Results Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing ‘conventional’ resection at the other three hospitals. Laparoscopic CME was performed in 258 (48·8 per cent) and laparoscopic ‘conventional’ resection in 1172 (68·9 per cent). More extended right colectomy procedures were done in the CME group (17·4 versus 3·6 per cent). The 90‐day mortality rate in the CME group was 6·2 per cent versus 4·9 per cent in the ‘conventional’ group (P = 0·219), with a propensity score‐adjusted logistic regression odds ratio (OR) of 1·22 (95 per cent c.i. 0·79 to 1·87). Laparoscopic surgery was associated with a lower risk of mortality at 90 days (OR 0·63, 0·42 to 0·95). Intraoperative injury to other organs was more common in CME operations (9·1 per cent versus 3·6 per cent for ‘conventional’ resection; P < 0·001), including more splenic (3·2 versus 1·2 per cent; P = 0·004) and superior mesenteric vein (1·7 versus 0·2 per cent; P < 0·001) injuries. Rates of sepsis with vasopressor requirement (6·6 versus 3·2 per cent; P = 0·001) and postoperative respiratory failure (8·1 versus 3·4 per cent; P < 0·001) were higher in the CME group. Conclusion CME is associated with more intraoperative organ injuries and severe non‐surgical complications than ‘conventional’ resection for colonic cancer. More operative injuries and postoperative sepsis
Bibliography:	ark:/67375/WNG-7F7T0W5R-W ArticleID:BJS10083 istex:E0D304961722C5C54D8B67EA23B080ABC055B2ED ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0007-1323 1365-2168
DOI:	10.1002/bjs.10083