For anyone about to undergo surgery: a few articles on Complete Mesocolic Excision

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I_will_fight
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Joined: Mon Jun 29, 2020 3:38 pm

For anyone about to undergo surgery: a few articles on Complete Mesocolic Excision

Postby I_will_fight » Sun Feb 14, 2021 1:34 am

Hi all,

Not sure how relevant this is for those that have already been operated, but hopefully it is useful for those that might be operated soon.

I have read a few articles on Complete Mesocolic Excision (CME) for colon cancer. This is becoming standard, but apparently it is not applied everywhere.

A couple of decades ago rectal cancer had a very high rate of local recurrence, then surgeons came up with a new technique called "Total mesorectal excision" (TME) which dramatically lowered the rate of local recurrence.

In the last 15 years surgeons have been trying to apply a TME-equivalent technique to colon cancer, they called it "CME", if you google "complete mesocolic excision outcomes" you will find many articles explaining the nature of this technique and the expected advantages

CME has been gaining traction in the last ten years and studies based on the long-term outcomes are slowly becoming available

The main result of CME vs Non-CME is collection of a greater number of lymphatic nodes, lowered local recurrence rate and improved disease-free survival in stages II and III.

https://www.thelancet.com/journals/lano ... 70-2045(19)30573-X/fulltext
Objective: Total mesorectal excision (TME) as proposed by R.J. Heald more than 20 years ago, is nowadays accepted worldwide for optimal rectal cancer surgery. This technique is focused on an intact package of the tumour and its main lymphatic drainage. This concept can be translated into colon cancer surgery, as the mesorectum is only part of the mesenteric planes which cover the colon and its lymphatic drainage like envelopes. According to the concept of TME for rectal cancer, we perform a concept of complete mesocolic excision (CME) for colonic cancer. This technique aims at the separation of the mesocolic from the parietal plane and true central ligation of the supplying arteries and draining veins right at their roots.

This study mentiones the improved "local recurrence free survival" (LRFS) for CME-operated patients.

https://journals.lww.com/annalsofsurger ... on.18.aspx
There were 220 patients in the CME group and 110 patients in the noncomplete mesocolic excision (NCME) group. Baseline characteristics were well balanced. Compared with NCME, CME was associated with a greater number of total lymph nodes (24 vs 20, P = 0.002). Postoperative complications did not differ between the 2 groups. CME had a positive effect on LRFS compared with NCME (100.0% vs 90.2%, log-rank P < 0.001). Mesocolic dissection (100.0% vs 87.9%, log-rank P < 0.001) and nontumor deposits (97.2% vs 91.6%, log-rank P < 0.022) were also associated with improved LRFS.

https://pubmed.ncbi.nlm.nih.gov/19016817/
Results: By consequent application of the procedure of CME, we were able to reduce local 5-year recurrence rates in colon cancer from 6.5% in the period from 1978 to 1984 to 3.6% in 1995 to 2002. In the same period, the cancer related 5-year survival rates in patients resected for cure increased from 82.1% to 89.1%.

https://pubmed.ncbi.nlm.nih.gov/31451917/

Results: Recurrence was observed in 13 (11.6%) patients and a significant association between disease stage and recurrence (P < 0.001) was found with a higher proportion of stage IV patients in the recurrence group (46.1% vs. 7.1%). During a median follow-up of 43 months (range 12-149), 13 deaths occurred, all of them due to disease progression. KM curves for all stages showed an estimated survival rate of 51% at 148 months.
Conclusion: Laparoscopic segmental resection with CME appears to be an oncologically safe and effective procedure for treatment of SFC and may be considered as a standard surgical method for elective management of the disease. In the future, routine lymph node mapping could be used to confirm this hypothesis.

https://www.researchgate.net/publicatio ... ic_surgery

...It has been hypothesized that surgical removal of micro metastases may offer an explanation for at least part of the benefit of CME in TNM stage II patients [24, 35]...
46 yo male Spain
06/20 - 6cm T3N0M0 CC splenic flex
No liver mets, 3 and 4 mm lung dots (unlikely to be mets)
lymp 0/37
MSH6- other MMR+
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, 13cm clear margins, optimistic surgn.
08/20 - CAPOX regime, 4 cycles.
11/20 - CAPOX completed. CAT scan: lesion in liver, suspect hemoangioma, no changes lung dots.
12/20 - Clean colonoscopy
02/21 - MRI liver lesion is nonspecific, stable.

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