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

Please feel free to read, share your thoughts, your stories and connect with others!
I_will_fight
Posts: 147
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
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
dMMR MSH6
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT

bromo
Posts: 2
Joined: Wed Mar 24, 2021 4:45 am

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

Postby bromo » Fri Mar 26, 2021 9:10 pm

Thank you for posting this. As someone just diagnosed and seeing the surgeon on Monday it is good information to have.

demievent
Posts: 3
Joined: Sun Mar 28, 2021 12:52 am

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

Postby demievent » Fri Apr 02, 2021 4:37 am

Hey,

Just wanted to say that my dad had CME with his right hemi-colectomy. It's still a growing procedure. It's supposed to be state of the art procedure for suitable resection procedures mostly done with robots (DaVinci machines) or laparoscopically. Make sure to choose a skilled surgeon who can perform CME as it's a bit complicated compared to normal resection surgeries. It's been found to have better outcomes than normal hemi-colectomy surgeries.

I_will_fight
Posts: 147
Joined: Mon Jun 29, 2020 3:38 pm

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

Postby I_will_fight » Mon Apr 05, 2021 3:18 pm

bromo wrote:Thank you for posting this. As someone just diagnosed and seeing the surgeon on Monday it is good information to have.


What did the surgeon tell you?
Did you get a definite date for your surgery?

Good luck!

Javi
46 yo male Spain
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
dMMR MSH6
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT

bromo
Posts: 2
Joined: Wed Mar 24, 2021 4:45 am

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

Postby bromo » Tue Apr 06, 2021 8:35 pm

Yes, I did. My surgery is next Wednesday, April 14th. So glad to finally have a date.

I_will_fight
Posts: 147
Joined: Mon Jun 29, 2020 3:38 pm

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

Postby I_will_fight » Wed Apr 14, 2021 12:39 pm

bromo wrote:Yes, I did. My surgery is next Wednesday, April 14th. So glad to finally have a date.


I hope it all goes well today! May you be cancer free when you read this!
46 yo male Spain
06/2020 - 6cm T3N0M0 CC splenic flex
3 and 4 mm lung ground glass
lymp 0/37
dMMR MSH6
KRAS mt G13D
V/LNI absent
PNI present
07/20 - hemicol surg, optimistic surgeon.
11/20 - 4 x CAPOX completed.
12/20 - Clear colonoscopy
02/21 - MRI liver lesion unchanged.
11/21 - Clear CT
02/22- Colonoscopy: Sessil polyp 3mm
05/22- Clear CT
06/22- Negative Signatera
12/22- Negative Signatera
01/23- Clear CT
07/23- Clear CT, normal markers.
09/23 - Negative Signatera
01/24 - Clear CT


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: No registered users and 27 guests

cron