title: Stage I-IIIC right colonic cancer treated with complete mesocolic excision and central vascular ligation: quality of surgical specimen and long term oncologic outcome according to the plane of surgery.
abstract: OBJECTIVE
  Complete removal of mesocolon "as an envelope" (complete mesocolic excision, CME) with central vascular ligation and apical node dissection (CVL) in the surgical management of right sided colonic cancer is a novel technique focused on resection of the colon surrounded by its intact primitive dorsal mesentery containing the tumors and all the routes of initial cancerous diffusion; our aim was to evaluate quality of surgical specimens and the relative impact on long-term oncologic outcome when compared to less radical planes of surgery.
  
  
  METHODS
  Data were collected in 159 staged I-IIIC right sided colon cancers operated on with the concept of CME and CVL, between 2008 and 2013.
  
  
  RESULTS
  Morbidity and mortality were 37.7% and 1.9% respectively. Overall and disease free survival were 80.5% and 69.8% at five years. Mesocolic, intramesocolic and muscolaris-mucosa planes of resection were achieved in 64.7%, 22.6% and 12.5% of cases, respectively: mesocolic plane of surgery impacted significantly on R0 resection rate (98%), CRM<1 mm (2.9%) and overall survival (81.5% at 5 years) when compared to muscolaris propria plane of surgery, with R0 resection rate and 5 years survival falling to 65% and 60%, respectively, and CRM<1 mm rising to 35%, being all statistically significant; statistical difference was also recorded for intramesocolic plane of resection, with survival, R0 resection rate and CRM<1 mm of 72.2%, 86.1% and 13.8%, respectively. Stratifying patients for stage of disease, CME with CVL significantly improved survival in stage II, IIIA/B and in a subgroup of IIIC patients, with not metastatically involved apical nodes.
  
  
  CONCLUSIONS
  CME with CVL follows the oncologic principle based on resection of the primitive embryological mesenterium as an intact envelope, along with central lymphadenectomy up to the apical nodes, translating in higher surgical specimens quality and significant impact on locoregional control and overall survival when compared to less radical planes of surgery.
authors.affiliation: Unit of General Surgery, Department of Surgery "Carlo Poma" Hospital, Mantua, Italy - lucamaria.siani@gmail.com.
authors.forename: L M
authors.initials: LM
authors.lastname: Siani
authors.forename: C
authors.initials: C
authors.lastname: Pulica
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003082:Colectomy / Q000379:methods; D044682:Colon, Ascending; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods; D008026:Ligation; D008197:Lymph Node Excision; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome