Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision?

• Published in: Colorectal disease Vol. 13; no. 10; pp. 1123 - 1129
• Main Authors: Bertelsen, C. A., Bols, B., Ingeholm, P., Jansen, J. E., Neuenschwander, A. U., Vilandt, J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-10-2011
• Subjects: Adult; Aged; Aged, 80 and over; Colectomy - adverse effects; Colectomy - methods; Colon cancer; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; complete mesocolic excision; Female; harvested lymph nodes; Humans; Lymph Node Excision; Male; Mesocolon - surgery; Middle Aged; Postoperative Complications; quality of surgery; vascular high tie
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2010.02474.x

Aim  we analysed the influence of standardization of colon cancer surgery with complete mesocolic excision (CME) on the quality of surgery measured by the pathological end‐points of number of harvested lymph nodes, high tie of supplying vessels, plane of mesocolic resection and rate of R0 resection.
Method  One hundred and ninety‐eight patients with colonic carcinoma who underwent radical surgery between September 2007 and February 2009 were divided into two groups, including those undergoing surgery before (93) or after (105) 1 June 2008, when complete mesocolic excision (CME) was introduced as standard in our hospital.
Results  The overall mean high tie increased from 7.1 (CI, 6.5–7.6) to 9.6 (8.9–10.3) cm (P < 0.0001) and the mean number of harvested lymph nodes from 24.5 (22.8–26.2) to 26.7 (24.6–28.8) (P = 0.0095). There were no significant increases in these end‐points in open right hemicolectomy, and in laparoscopic sigmoid resection the number of lymph nodes did not increase significantly. The plane of mesocolic resection, the rate of R0 resection and the risk of complications did not change significantly. The median (range) length of hospital stay increased from 4 (2–62) to 5 (2–71) days (P = 0.04).
Conclusion  Standardization of colonic cancer surgery with CME seems to improve the quality of surgery without increasing the risk of complications.