Wide excision in right-sided colon cancer is associated with decreased survival.
OBJECTIVE
Nodal involvement is the most important prognostic factor in colon cancer. Although theoretically appealing, it is not known if wider mesenteric excision improves the oncological result. The aim of this retrospective study was to investigate whether wider mesenteric excision yields a superior oncological result.


METHODS
Depending on the resection length, 333 cases of locally radical right-sided hemicolectomies due to adenocarcinoma were compared for perioperative morbidity and mortality, disease-free survival, and long-term survival.


RESULTS
Postoperative mortality was significantly higher in the quartile with the longest resections, p = 0.003. In a multivariate analysis adjusted for age, stage, emergency operation, adjuvant chemotherapy, and year of operation, a negative relationship between resection length and 5-year overall survival was noted, p = 0.01. No differences in the causes of death or in the incidence of local or distant recurrences were noted between groups.


CONCLUSIONS
Wider excision in right-sided hemicolectomies was not associated with any oncological benefit but an increased postoperative mortality and a decreased 5-year overall survival. These findings may suggest consideration to perform wide mesenteric resections routinely. Further research is warranted to define which patients benefit from wider resections.
Department of Surgery, Skåne University Hospital, Malmö, Sweden.
F
F
Olofsson
P
P
Buchwald
S
S
Elmståhl
I
I
Syk
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
Colon cancer; high tie; mesenteric excision; right hemicolectomy; surgery; surgical technique