title: Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study.
abstract: OBJECTIVE
  Complete mesocolic excision (CME) with central vascular ligation (CVL) has been proposed for treatment of colon cancers based on the same principles as total mesorectal excision. Impressive outcomes have been reported, however, direct comparisons with the classic procedure are lacking.
  
  
  METHODS
  Forty-five consecutive patients operated on in the last 5 years with CME and CVL right hemicolectomy entered the study. Fifty-eight right-sided colon cancer patients operated in the previous 5 years with classic approach constituted the control group. Intra- and postoperative course assessed the safety of the procedure. Primary end-points for oncological adequacy were recurrence and survival rate.
  
  
  RESULTS
  All operations were successful with no increase in postoperative complications (p = 0.85). Number of harvested nodes and length of vascular ligation were shown to be significantly better in the CME group (p < 0.01). A higher number of tumor deposits were harvested thus allowing chemotherapy in newly upstaged patients. Locoregional recurrences were never experienced in CME patients (p = 0.03). The risk of cancer-related death was reduced by over one half in all CME patients, and even by three quarters in node-positive tumors. The classic operation was significantly associated with poor outcome (p < 0.01).
  
  
  CONCLUSIONS
  This study shows that CME with CVL is a safe and effective surgical approach for right colon cancer, thus confirming the previously reported oncological adequacy. The procedure was shown to significantly decrease local recurrences and to improve the survival rate, particularly in node-positive patients. Urgent diffusion of this technique is warranted.
authors: Division of Surgical Oncology, F. Magrassi-A. Lanzara" Department of Clinical and Experimental Medicine and Surgery, School of Medicine, Second University of Naples, c/o II Policlinico, Edificio 17 Via Pansini, 5, 80131, Naples, Italy, gennaro.galizia@unina2.it.
authors: Gennaro
authors: G
authors: Galizia
authors: Eva
authors: E
authors: Lieto
authors: Ferdinando
authors: F
authors: De Vita
authors: Francesca
authors: F
authors: Ferraraccio
authors: Anna
authors: A
authors: Zamboli
authors: Andrea
authors: A
authors: Mabilia
authors: Annamaria
authors: A
authors: Auricchio
authors: Paolo
authors: P
authors: Castellano
authors: Vincenzo
authors: V
authors: Napolitano
authors: Michele
authors: M
authors: Orditura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008026:Ligation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008646:Mesocolon / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
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