Minimally-Invasive Conventional Right Colectomy Versus Complete Mesocolic Excision for Right-Colon Adenocarcinoma: A Single-Institution Cohort

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INTRODUCTION: The benefits of complete mesocolic excision (CME) versus conventional right colectomy in right-sided colon cancer remain to be defined, as these relate to reduced nodal recurrence and increased disease-free survival (DFS). Optimal patient selection also appears crucial in selecting the best surgical technique for right colon cancer. METHODS: A prospective, single-center database analyzing minimally invasive CME versus conventional colectomy in right-sided colon cancer was retrospectively analyzed. Only patients with free surgical margins and without distant metastases were included for analysis. The outcomes analyzed comprised local recurrence, nodal recurrence, DFS, length of stay, node harvesting, and major postoperative complications. The analysis was adjusted for multiple confounders, including age, sex, BMI, pathological T stage, pathological N stage, mismatch repair protein deficiency, adjuvant chemotherapy, first postoperative carcinoembryonic antigen (CEA) level, and American Society of Anesthesiologists Physical Status Classification System (ASA) score. RESULTS: CME presented a similar safety profile, with increased lymph node yield. CME was associated with a significant reduction in the risk of nodal recurrence (adjusted relative risk (RR) = 0.08; 95% CI: 0.05 to 0.09; p < 0.001). Moreover, in the propensity score matching (PSM) analysis, CME was associated with a significant coefficient of reduction for nodal recurrence (Coef. = -0.14; 95% CI: -0.23 to -0.05; p = 0.01). An improvement in DFS was also observed (hazard ratio (HR) = 0.03; 95% CI: 0.003 to 0.27; p = 0.002) in patients with pT3/pT4 or pN+ disease. CONCLUSION: Minimally invasive CME may be associated with decreased nodal recurrence and increased DFS in patients with right colon cancer.

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