title: Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II.
abstract: BACKGROUND
  The aim of the present study was to investigate whether the new method of complete mesocolic excision (CME) with a high (apical) vascular tie (D3 resection) had an immediate effect compared with a conventional (standard) approach even in those patients without lymph node metastases.
  
  
  METHODS
  A cohort of 189 consecutive patients with tumour-nodal-metastasis (TNM) stages I-II and a mean age of 73 years were operated on in the period from January 2007 to December 2008 in three community teaching hospitals. The CME approach (n = 89), used in hospital A, was compared to the standard technique used (n = 105) in two other hospitals, B and C. Lymph node yields from the specimens were used as a surrogate measure of radical resections. Outcome was analysed after a median follow-up of 50.2 months.
  
  
  RESULTS
  In-hospital mortality rate was 2.8 % in the CME group and 8.6 % in the standard group. The 3-year overall survival (OS) in the CME group was 88.1 versus 79.0 % (p = 0.003) in the standard group, and the corresponding disease-free survival (DFS) was 82.1 versus 74.3 % (p = 0.026). Cancer-specific survival was 95.2 % in the CME group versus 90.5 % in the standard group (p = 0.067). Age, operative technique, and T category were significant in multiple Cox regressions of OS and DFS.
  
  
  CONCLUSIONS
  Compared with the standard (D2) approach, introduction of CME surgical management of colon cancer resulted in a significant immediate improvement of 3-year survival for patients with TNM stage I-II tumours as assessed by OS and DFS.
authors.affiliation: Department of Surgery, Haraldsplass Deaconess Hospital, University of Bergen, POB 6165, 5892, Bergen, Norway.
authors.forename: K E
authors.initials: KE
authors.lastname: Storli
authors.forename: K
authors.initials: K
authors.lastname: Søndenaa
authors.forename: B
authors.initials: B
authors.lastname: Furnes
authors.forename: I
authors.initials: I
authors.lastname: Nesvik
authors.forename: E
authors.initials: E
authors.lastname: Gudlaugsson
authors.forename: I
authors.initials: I
authors.lastname: Bukholm
authors.forename: G E
authors.initials: GE
authors.lastname: Eide
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D008297:Male; D008643:Mesentery / Q000473:pathology / Q000601:surgery*; D008646:Mesocolon / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome