LAPAROSCOPIC COMPLETE MESOCOLIC EXCISION WITH D3 LYMPHADENECTOMY FOR SIGMOID COLON CANCER: LONG-TERM OUTCOMES AND PROGNOSTIC FACTORS
Main Article Content
Abstract
Objectives: To evaluate the feasibility, safety, and oncological outcomes of laparoscopic complete mesocolic excision (CME) combined with D3 lymphadenectomy for sigmoid colon cancer. Methods:A retrospective study included 149 patients with sigmoid colon cancer who underwent laparoscopic CME with D3 lymphadenectomy at the 108 Military Central Hospital between June 2018 and June 2022. Results: The mean operative time was 134.2 ± 30.6 minutes. Early postoperative complication rates were low (anastomotic leakage 2.1%, wound infection 2.7%, bowel obstruction 1.3%), and no 30-day mortality was recorded. After a mean follow-up of 31.2 months, overall survival rates at 1, 2, 3, and 5 years were 97.9%, 93.0%, 89.9%, and 86.8%, respectively. The recurrence occurred in 10.7% of patients, mainly due to hepatic metastases (4.7%). Multivariate analysis identified tumor stage (HR = 1.4; p < 0.01) and histological differentiation (HR = 1.3; p = 0.02) as independent prognostic factors. Conclusion: Laparoscopic CME with D3 lymphadenectomy is a safe, feasible, and oncologically effective procedure, providing favorable long-term survival outcomes.
Keywords
Laparoscopic complete mesocolic excision with D3 lymph node dissection, Sigmoid colon cancer, Long-term outcomes and prognostic factors
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References
2. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020 Jan; 25(1):1-42.
3. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: Complete mesocolic excision and central ligation technical notes and outcome. Colorectal Dis Off J Assoc Coloproctology G B Irel. 2009 May; 11(4):354-364.
4. Ow ZGW, Sim W, Nistala KRY, Ng CH, Koh FHX, Wong NW, et al. Comparing complete mesocolic excision versus conventional colectomy for colon cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2021 Apr 1; 47(4):732-737.
5. Abdelkhalek M, Setit A, Bianco F, Belli A, Denewer A, Youssef TF, et al. Complete mesocolic excision with central vascular ligation in comparison with conventional surgery for patients with colon cancer - the experiences at two centers. Ann Coloproctology. 2018 Aug 31; 34(4):180-186.
6. Crane J, Hamed M, Borucki JP, El‐Hadi A, Shaikh I, Stearns AT. Complete mesocolic excision versus conventional surgery for colon cancer: A systematic review and meta‐analysis. Colorectal Dis. 2021 July; 23(7):1670-1686.
7. Qaderi SM, Galjart B, Verhoef C, Slooter GD, Koopman M, Verhoeven RHA, et al. Disease recurrence after colorectal cancer surgery in the modern era: A population-based study. Int J Colorectal Dis. 2021 Nov; 36(11):2399-2410.
8. Sato A, Imaizumi K, Kasajima H, Ichimura K, Sato K, Yamana D, et al. Short- and long-term outcomes of preservation versus ligation of the inferior mesenteric artery in laparoscopic D3 lymph node dissection for descending colon cancer: A propensity score-matched analysis. Langenbeck's Arch Surg. 2023 Jan 13; 408(1):23.
9. Díaz-Vico T, Fernández-Hevia M, Suárez-Sánchez A, García-Gutiérrez C, Mihic-Góngora L, Fernández-Martínez D, et al. Complete mesocolic excision and d3 lymphadenectomy versus conventional colectomy for colon cancer: A systematic review and meta-analysis. Ann Surg Oncol. 2021 Dec 1; 28(13):8823-8837.
10. Luo X, E Y, Wu J, Lu C, Zhang J. Analysis of prognostic factors in different grades of histologic differentiation in colorectal cancer patients receiving preoperative neoadjuvant chemotherapy and establishment of prognostic nomograms for moderately differentiated grade. Int J Colorectal Dis. 2023 Sept 25; 38(1):237.