Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery

Background Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with ‘conventional’ surgery, but there is a potential for higher morbidity. Methods Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 20...

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Bibliographic Details
Published in:British journal of surgery 2016-04, Vol.103 (5), p.581-589
Main Authors: Bertelsen, C. A., Neuenschwander, A. U., Jansen, J. E., Kirkegaard-Klitbo, A., Tenma, J. R., Wilhelmsen, M., Rasmussen, L. A., Jepsen, L. V., Kristensen, B., Gögenur, I.
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - surgery
Aged
Aged, 80 and over
Colectomy - methods
Colonic Neoplasms - mortality
Colonic Neoplasms - surgery
Databases, Factual
Female
Humans
Laparoscopy
Logistic Models
Male
Mesocolon - surgery
Middle Aged
Postoperative Complications - etiology
Propensity Score
Retrospective Studies
Treatment Outcome
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Summary:Background Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with ‘conventional’ surgery, but there is a potential for higher morbidity. Methods Data for patients after elective resection at the four centres in the Capital Region of Denmark (June 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study). Results Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing ‘conventional’ resection at the other three hospitals. Laparoscopic CME was performed in 258 (48·8 per cent) and laparoscopic ‘conventional’ resection in 1172 (68·9 per cent). More extended right colectomy procedures were done in the CME group (17·4 versus 3·6 per cent). The 90‐day mortality rate in the CME group was 6·2 per cent versus 4·9 per cent in the ‘conventional’ group (P = 0·219), with a propensity score‐adjusted logistic regression odds ratio (OR) of 1·22 (95 per cent c.i. 0·79 to 1·87). Laparoscopic surgery was associated with a lower risk of mortality at 90 days (OR 0·63, 0·42 to 0·95). Intraoperative injury to other organs was more common in CME operations (9·1 per cent versus 3·6 per cent for ‘conventional’ resection; P 
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.10083