title: No benefit of extended mesenteric resection with central vascular ligation in right-sided colon cancer.
abstract: OBJECTIVE
  The optimal extent of mesenteric resection in colon cancer surgery is not known. We have previously shown an increased mortality associated with wider mesenteric resection in right hemicolectomy. This study compares the short- and long-term outcome in three variations of right hemicolectomy based on the position of the vascular ligature in the mesentery.
  
  
  METHODS
  In all, 2084 cases of cancer in the caecum or ascending colon were identified in the Swedish Colorectal Cancer Registry and categorized according to the position of the vascular ligature: central ligation of ileocolic vessels (ICVs) ± right colic vessels (n = 390), central ligation of ICVs + right branch of middle colic vessels (MCVs) (n = 1360) and central ligation of ICVs + central ligation of MCVs (n = 334).
  
  
  RESULTS
  Neither 3-year overall survival, 3-year disease-free survival nor local recurrence rate differed between the groups (P = 0.604; P = 0.247; P = 0.237). There was still no difference after multivariate analysis adjusted for age, sex, American Society of Anesthesiologists classification, TNM stage and adjuvant therapy. An increased peri-operative mortality, however, was observed in extended mesenteric resections, increasing from 0.8% in non-extended to 3.6% in more extended resection, P = 0.025.
  
  
  CONCLUSIONS
  The study showed no survival benefit by more extended mesenteric resection, indicating that there is no need to extend the mesenteric resection to involve the MCVs in cancer of the caecum or ascending colon. On the contrary, increased peri-operative mortality by more extensive mesenteric resection was noted suggesting that a more conservative approach may be favourable.
authors.affiliation: Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Olofsson
authors.affiliation: Department of Surgery, Helsingborg Hospital, Lund University, Lund, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Buchwald
authors.affiliation: Division of Geriatric Medicine, Department of Health Sciences, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Elmståhl
authors.affiliation: Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Syk
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery*; D002432:Cecum / Q000473:pathology / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000098:blood supply; D044682:Colon, Ascending / Q000473:pathology / Q000601:surgery; D044684:Colon, Transverse / Q000473:pathology / Q000601:surgery; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007082:Ileum / Q000098:blood supply; D008026:Ligation; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden
keywords: Colon cancer; high tie; mesenteric excision; right hemicolectom; surgery; surgical technique