title: Laparoscopic Wide Mesocolic Excision and Central Vascular Ligation for Carcinoma of the Colon.
abstract: OBJECTIVE
  The principle of complete mesocolic excision for colon cancer has been introduced to improve oncologic outcome. However, this approach is scantily discussed for laparoscopic surgery and there is a lack of randomized trials. This study examined oncologic and clinical outcome after laparoscopic wide mesocolic excision and central vascular ligation for colon cancer.
  
  
  METHODS
  This is a review of prospectively gathered data from a single-institution colorectal cancer database. This study was conducted in the Central Hospital of Central Finland. From January 2003 to December 2011, 222 patients underwent laparoscopic colonic resections with wide mesocolic excision and central vascular ligation in the multimodal setting. The main measures of outcome were cancer recurrence and survival, with early recovery, 30d-mortality and morbidity, reoperation, readmission, and late complications as secondary outcomes.
  
  
  RESULTS
  The median follow-up was 5.5 (interquartile range (IQR) = 3.7-8.0) years. The 5-year overall survival for all 222 patients was 80.2% and disease-specific survival was 87.5%, and for those 210 R0-patients with stage I-III disease, 83.9% and 91.3%, respectively. The 5-year disease-free survival was 85.8%: stage I was 94.7%, stage II was 90.8%, and stage III was 75.6% ( p = 0.004). Increasing lymph node ratio significantly decreased the 5-year disease-free survival. Conversion rate to open surgery was 12.2%. Thirty-day mortality was 1.3% and morbidity, 19.7%. Median postoperative hospital stay was 5 (IQR = 3-7) days.
  
  
  CONCLUSIONS
  Laparoscopic wide mesocolic excision and central vascular ligation for colon cancer resulted in good long-term oncologic outcome. Randomized trials are needed to show that laparoscopic complete mesocolic excision technique would become the standard of care for the carcinoma of the colon.
authors.affiliation: 1 Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Ehrlich
authors.affiliation: 1 Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Kairaluoma
authors.affiliation: 2 Department of Pathology, Central Hospital of Central Finland, Jyväskylä, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Böhm
authors.affiliation: 3 Department of Oncology, Central Hospital of Central Finland, Jyväskylä, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Vasala
authors.affiliation: 4 Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, University of Helsinki, Helsinki, Finland.|5 Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Kautiainen
authors.affiliation: 1 Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland.
authors.forename: I
authors.initials: I
authors.lastname: Kellokumpu
keywords: Laparoscopy; colon cancer; multimodal treatment; short- and long-term outcome