Surgical, Pathological and Oncological Outcomes of Laparoscopic Conventional Colectomy Versus Complete Mesocolic Excision for Operable Colon Cancer Cases in Upper Egypt

Brief Summary

Detailed Description

Colon cancer is considered a huge clinical surgical burden accounting for 10% of cancer cases and deaths all over the world with consideration that surgery and adjuvant chemotherapy(if indicated) are the main lines of treatment . When Werner Hohenberger and colleagues described complete mesocolic excision (CME) in 2009; resection along the embryological and lymphovascular planes with appropriate resection margins, they did it for years before describing it with suggestion of improved disease outcomes and overall survival compared to the conventional colectomy (CC). The principles of CME were described after the significant improvement of rectal adenocarcinoma surgical outcomes with establishment of total mesorectal excision (TME) in which tumor resection is associated with dissection of mesorectal fascial embryologic and lymphovascular planes. CME includes the same principles of the CC with maximizing lymph node dissection level into (D3 extended lymphadenectomy instead of D1 and D2 in conventional colectomy) and central vascular ligation (CVL) of the main feeding vessel(s) at their origin, with suggested improved disease-free and overall survival with suggested superior pathological and oncological results in the specimen. Some surgeons consider that CME; with D3 extended lymphadenectomy and CVL is the optimal or standard surgical method in primary cancer colon based on suggested reduced local recurrence and improved disease-free and overall survival. Although CME has a theoretical advantages and promising early results, it is not widely adopted as the standard in some areas. CME is technically more demanding than CC and suggested to be associated with more intraoperative visceral injuries and non-surgical complications and many doubts persist about safety and efficacy of the procedure. The questions of interest and research, should CME be regarded as the optimal procedure for colon cancer cases? And also another question; is conventional colectomy suboptimal?

Primary Outcomes

Secondary Outcomes

• Wound dehiscence(4 weeks postoperative)
• Preoperative haemoglobin level(preoperative)
• Preoperative histopathological result(2 weeks preoperative)
• Neurological complications(4 weeks postoperative)
• Conversion to open surgery(intraoperative)
• Neoadjuvant therapy(2 weeks Preoperative)
• Average daily amount in intraperitoneal drain(2 weeks Postoperative)
• Postoperative ileus(2 weeks postoperative)
• Type of colonic anastomosis(Intraoperative)
• Cardiopulmonary complications(4 weeks postoperative)
• application of subcutaneous suction(1 week Postoperative)
• Age(preoperative)
• Site of cancer colon(2 weeks preoperative)
• Preoperative preparation(3 days Preoperative)
• Wound infection(2 weeks postoperative)
• Average daily amount in subcutaneous suction(2 weeks Postoperative)
• Preoperative colonoscopic examination result(2 weeks preoperative)
• Hospital stay(4 weeks postoperative)