Minimally- invasive Conventional right colectomy versus complete mesocolic excision for right-colon adenocarcinoma: a single-institution cohort

Introduction : The benefits of complete mesocolic excision (CME) versus conventional right colectomy (CRH) in right-side colon cancer remain to be defined, as it relates to reduced nodal recurrence and increase in disease-free survival (DFS). Optimal patient selection also seems to play a crucial role in choosing the best surgical technique for right-colon cancer. Methods : a retrospective analysis of a prospective, single center database analyzing minimally-invasive CME vs CRH in right side colon cancer. Only patients with free surgical margins and without distant metastasis were included for analysis. Outcomes analyzed included 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; Pathologic T stage; Pathologic N stage; Mismatch repair protein deficiency; Adjuvant chemotherapy ; First postoperative CEA level; ASA score. Results : CME presented a similar safety profile, with increased in lymph node yield. CME was associated with a significant reduction in the risk for nodal recurrence (adjusted RR = 0.08; 95% CI: 0.05 to 0.09; p < 0.001). Also in the propensity-score matching 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 disease-free survival was also observed (HR = 0.03; 95% CI: 0.003 to 0.27; p = 0.002) in patients with pT3/pT4 or pN+ disease. Meaning : Minimally-invasive CME may be associated with decrease in nodal recurrence and increase disease-free survival in patients with right colon cancer.