title: Laparoscopic complete mesocolic excision with central vascular ligation in 600 right total mesocolectomies: Safety, prognostic factors and oncologic outcome.
abstract: BACKGROUND
  To analyze our experience with laparoscopic right Mesocolectomy in right colonic cancers.
  
  
  METHODS
  600 consecutive patients were studied.
  
  
  RESULTS
  Mortality was 0.5%; morbidity was 35.5%. Mean mesocolic area was 15339 ± 1639 mm3, specimen length 24.3 ± 3.3 cm, distance from the tumor to high tie was 103 ± 6 mm and mean lymph nodes harvested was 27 ± 3; mesocolic plane was achieved in 81% of cases. Survival was 83%; stratified survival in patients with stage II, IIIA/B and in the subgroup of stage IIIC patients with negative apical nodes was 88.7%, 72.4%, 71.4% respectively; stage IIIC patients with positive apical nodes showed poor survival (27.7%). Recurrence occurred in 177 patients (29.5%) and was mainly systemic (22.7%). At the multivariate analysis, "non mesocolic" plane of resection, positive N3 apical nodes and CEA levels >5 ng/dL were found to be independent prognostic factors.
  
  
  CONCLUSIONS
  Laparoscopic right Mesocolectomy showed to be safe and yielded surgical specimens of high quality, with impact on survival; positive N3 apical nodes and "non mesocolic" planes were independently associated to poor outcome.
authors.affiliation: General, Thoracic and Minimally Invasive Surgery Unit, Azienda Unica della Romagna, Ceccarini Hospital, Riccione, Italy. Electronic address: lucamaria.siani@gmail.com.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Siani
authors.affiliation: General, Thoracic and Minimally Invasive Surgery Unit, Azienda Unica della Romagna, Ceccarini Hospital, Riccione, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lucchi
authors.affiliation: General, Thoracic and Minimally Invasive Surgery Unit, Azienda Unica della Romagna, Ceccarini Hospital, Riccione, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Berti
authors.affiliation: General, Thoracic and Minimally Invasive Surgery Unit, Azienda Unica della Romagna, Ceccarini Hospital, Riccione, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Garulli
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003106:Colon / Q000098:blood supply; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Central vascular ligation; Complete mesocolic excision; Oncologic outcome; Quality of surgical specimen; Right sided colonic cancer; Safety