title: Quality of surgery for stage III colon cancer: comparison between England, Germany, and Japan.
abstract: BACKGROUND
  A number of studies have demonstrated that lymph node metastasis is a poor prognostic factor in colon cancer. Advances of surgical procedure have improved the outcomes of colon cancer treatment. The aim of this study was to compare the characteristics of surgery for stage III colon cancer between England, Germany, and Japan.
  
  
  METHODS
  Using the data of patients with colon cancer from one English, one German, and two Japanese centers, the characteristics of clinicopathologic features were compared. Conventional surgery, complete mesocolic excision (CME) with central vascular ligation, and D3 lymph node dissection were performed in England, Germany, and Japan, respectively.
  
  
  RESULTS
  Nineteen English, 26 German, and 60 Japanese patients were enrolled. There was no difference in tumor location, pT, and pN factors among the three groups. The length of resected bowel and the area of resected mesentery of the English and CME specimens were significantly greater than those of the D3 specimens (P < 0.0001 and P < 0.0001, respectively), whereas the length of the vascular tie to the bowel wall was similar between the CME and D3 specimens (P = 0.87), which was longer than that of the English specimens. The number of lymph nodes retrieved in the CME specimens was greatest among three groups (P < 0.0001), although the number of positive nodes was comparable (P = 0.64). The rates of mesocolic plane surgery in the English, CME, and D3 specimens were 47.4, 88.5, and 71.7 %, respectively (P = 0.022).
  
  
  CONCLUSIONS
  Three types of surgery for colon cancer differed in terms of the length of the resected bowel and the area of mesentery, although the length of the vascular tie to the bowel wall was similar between CME and D3 specimens. The high rates of mesocolic plane surgery were demonstrated in the CME and D3 specimens.
authors.affiliation: Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Tokyo, Japan, h-kobayashi.srg2@tmd.ac.jp.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: West
authors.forename: Keiichi
authors.initials: K
authors.lastname: Takahashi
authors.forename: Aristoteles
authors.initials: A
authors.lastname: Perrakis
authors.forename: Klaus
authors.initials: K
authors.lastname: Weber
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.forename: Philip
authors.initials: P
authors.lastname: Quirke
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000368:Aged; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D019984:Quality Indicators, Health Care