CONVENTIONAL RIGHT HEMICOLECTOMY VS. COMPLETE MESOCOLON EXCISION: ANALYSIS OF LOCOREGIONAL RECURRENCE

Introduction Complete mesocolon excision may be associated with lower rates of lymph node recurrence in right colectomy for colon adenocarcinoma. The objective of this study was to compare conventional right colectomy with complete mesocolon excision (CME) for right colon adenocarcinoma. A retrospective cohort study was conducted at the Vila Santa Catarina Hospital (Sociedade Beneficente Israelita Brasileira Albert Einstein), São Paulo, Brazil.

Methods Adult patients (>18 years) diagnosed with right colon adenocarcinoma were included. Only minimally invasive right colectomies (laparoscopic or robotic) were considered. The inclusion period was from 2019 to 2024. CME was defined as right colectomy with central ligation of the ileocolic, right colic, and right branch of the colon arteries; mesenteric dissection through the embryonic layer; and D3 lymphadenectomy. Our primary outcome was locoregional recurrence, defined as nodal disease or local recurrence after the start of follow-up for cancer. Disease-free survival was defined as the absence of locoregional or distant recurrence after surgery. We performed survival analysis for disease-free survival and multivariate Poisson regression to obtain risk ratios for locoregional recurrence between the groups after adjustment for: - Age; - Sex; - BMI ; - Pathological T stage ; - Pathological N stage; - Mismatch repair protein deficiency; - Neoadjuvant chemotherapy; - Adjuvant chemotherapy; - First postoperative CEA level; - Hypertension; - Diabetes Mellitus; - ASA score.

Results A total of 154 cases were included for analysis, 26 in the CME cohort and 128 in the conventional cohort. No local recurrences were observed in either group. Nodal recurrence was observed in 6 patients in the conventional cohort (incidence of 9.52%). No nodal recurrence was observed in the CME group. The mean time to nodal recurrence was 28 months (SD 10 months). The main predictors of nodal recurrence were pT4 and pN2 stages. After adjusting for multiple confounding factors, CME was associated with a significant reduction in the risk of nodal recurrence (adjusted RR = 0.08; 95% CI: 0.05 to 0.09; p < 0.001) and a significant increase in disease-free survival (HR = 0.03; 95% CI: 0.003 to 0.27; p = 0.002).

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025