Annals of Coloproctology

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Complete Mesocolic Excision With Central Vascular Ligation in Comparison With Conventional Surgery for Patients With Colon Cancer – The Experiences at Two Centers: Mohamed Abdelkhalek, Ahmed Setit, Francesco Bianco, Andrea Belli, Adel Denewer, Tamer Fady Youssef, Armando Falato, Giovanni Maria Romano; Ann Coloproctol. 2018;34(4):180-186. Published online August 31, 2018; DOI: https://doi.org/10.3393/ac.2017.08.05

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Purpose
Revolutions have occurred over the last 3 decades in the management of patients with colorectal cancer. Most advances were in rectal cancer surgery, especially after the introduction of the total mesorectal excision (TME) by Heald. However, no parallel advances regarding colon cancer surgeries have occurred. In 2009, Hohenberger introduced a new concept trying to translate the survival advantages of TME to patients with colon cancer. This relatively new concept of a complete mesocolic excision (CME) with central vascular ligation (CVL) in the management of patients with colon cancer represents an evolution in operative technique. We performed a comparative study between CME with CVL and conventional surgery for patients with colon cancer at Italian and Egyptian cancer centers, considering surgical quality and clinical outcome.
Methods
Seventy-nine Egyptian patients underwent conventional surgery (non-CME group) while 52 Italian patients underwent CME with sharp dissection between the embryological planes and CVL of the supplying vessels (CME group).
Results
Significantly better results were observed in terms of lymph node yield (CME group: 22.5 vs. non-CME group: 12; P < 0.0001) and lymph node ratio (CME group: 0.03 vs. non-CME group: 0.22; P < 0.0001). Regarding surgical morbidity, no significant difference was noted (CME group: 2 vs. non-CME group: 5; P < 0.702).
Conclusion
CME appears to be a safe procedure when performed by experienced hands through proper embryological planes. It also provides a superior specimen, with a higher lymph node yield, which consequently affects the lymph node ratio. Eventually, CME with CVL should be increasingly adopted and studied more deeply.

Citations

Citations to this article as recorded by

Laparoscopic Versus Open Complete Mesocolic Excision and Central Vascular Ligation in Right-Sided Colon Cancer: A Tertiary Center Experience
Mohamed Abdelkhalek, Mosab Shetiwy, Mohamed Elbadrawy, Ahmed Abdallah, Abdullah Altowairqi, Amr Sedky
Indian Journal of Surgery.2025; 87(S1): 52. CrossRef
Comparison of short-term outcomes of D2 and D3 lymph nodes dissection for colon cancer
V. V. Balaban, M. G. Mutyk, N. V. Bondarenko, S. E. Zolotukhin, O. V. Sovpel, I. V. Sovpel, M. M. Klochkov, D. S. Zykov, I. V. Rublevskyi, I. A. Tulina, V. M. Nekoval, S. I. Barkhatov, A. E. Vasilyev, P. V. Tsarkov
Surgery and Oncology.2024; 14(1): 51. CrossRef
Clinical validation of 3D virtual modelling for laparoscopic complete mesocolic excision with central vascular ligation for proximal colon cancer
Emma C. Kearns, Alice Moynihan, Jeffrey Dalli, Mohammad Faraz Khan, Sneha Singh, Katherine McDonald, Jessica O'Reilly, Niamh Moynagh, Christian Myles, Ann Brannigan, Jurgen Mulsow, Conor Shields, James Jones, Helen Fenlon, Leo Lawler, Ronan A. Cahill
European Journal of Surgical Oncology.2024; 50(11): 108597. CrossRef
Efficacy and Feasibility of Complete Mesocolic Excision with Central Vascular Ligation in Complicated Colorectal Cancer
Radwan A. Torky, Mohamed Abdel-Tawab, Abadeer Rafaat, Ahmed Mubarak Hefni, Ahmed Abdelmotaleb
Indian Journal of Surgical Oncology.2023; 14(2): 312. CrossRef
Step-by-step approach with anatomical highlights in SMV-first laparoscopic right colectomy
P. Tipmanee, S. Malakorn
Techniques in Coloproctology.2023; 27(3): 241. CrossRef
Right colon cancer: The influence of specific location on recurrence and survival
Ana Sofia Cavadas, Eduarda Gonçalves, Carlos Costa Pereira, Jorge Rodrigues, Joaquim Costa Pereira
Cancer Treatment and Research Communications.2023; 36: 100724. CrossRef
Macroscopic Evaluation of Colon Cancer Resection Specimens
Ross Jarrett, Nicholas P. West
Cancers.2023; 15(16): 4116. CrossRef
Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study
Domenica Carmen Testa, Lorenzo Mazzola, Giuseppe di Martino, Roberto Cotellese, Federico Selvaggi
ANZ Journal of Surgery.2022; 92(1-2): 132. CrossRef
The Prognostic Significance of Lymph Node Status and Lymph Node Ratio (LNR) on Survival of Right Colon Cancer Patients: a Tertiary Center Experience
Mosab Shetiwy, Amr F Elalfy, Osama Eldamshety, Ramy Abbas, Mohamed Abdelkhalek
Journal of Gastrointestinal Cancer.2021; 52(3): 1010. CrossRef
Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis
Ottavia De Simoni, Andrea Barina, Antonio Sommariva, Marco Tonello, Mario Gruppo, Genny Mattara, Antonio Toniato, Pierluigi Pilati, Boris Franzato
International Journal of Colorectal Disease.2021; 36(5): 881. CrossRef
D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis
Zutoia Balciscueta, Izaskun Balciscueta, Natalia Uribe, Gianluca Pellino, Matteo Frasson, Eduardo García-Granero, Álvaro García-Granero
European Journal of Surgical Oncology.2021; 47(7): 1541. CrossRef
Complete mesocolic excision versus conventional surgery for colon cancer: A systematic review and meta‐analysis
Jasmine Crane, Mazin Hamed, Joseph P. Borucki, Ahmed El‐Hadi, Irshad Shaikh, Adam T Stearns
Colorectal Disease.2021; 23(7): 1670. CrossRef
Complete Mesocolic Excision and D3 Lymphadenectomy versus Conventional Colectomy for Colon Cancer: A Systematic Review and Meta-Analysis
Tamara Díaz-Vico, María Fernández-Hevia, Aida Suárez-Sánchez, Carmen García-Gutiérrez, Luka Mihic-Góngora, Daniel Fernández-Martínez, José Antonio Álvarez-Pérez, Jorge Luis Otero-Díez, José Electo Granero-Trancón, Luis Joaquín García-Flórez
Annals of Surgical Oncology.2021; 28(13): 8823. CrossRef
Central vascular ligation and mesentery based abdominal surgery
M. Franceschilli, D. Vinci, S. Di Carlo, B. Sensi, L. Siragusa, A. Guida, P. Rossi, V. Bellato, R. Caronna, S. Sibio
Discover Oncology.2021;[Epub] CrossRef
Complete Mesocolic Excision With Central Vascular Ligation for the Treatment of Patients With Colon Cancer
Hyeong-Rok Kim
Annals of Coloproctology.2018; 34(4): 165. CrossRef

Standardizing the Protocols for Enhanced Recovery From Colorectal Cancer Surgery: Are We a Step Closer to Ideal Recovery?: Mosab Shetiwy, Tamer Fady, Fayez Shahatto, Ahmed Setit; Ann Coloproctol. 2017;33(3):86-92. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.86

7,220 View
80 Download
15 Web of Science
16 Citations

Abstract PDF

Purpose

Enhanced recovery protocols are being implemented into the standard of care in surgical practice. This study aimed to insert a steadfast set of elements into the perioperative care pathway to establish an improved recovery program for colorectal cancer patients.

Methods

Seventy patients planned for elective laparoscopic colorectal resection were randomized into 2 groups: conventional recovery group (n = 35) and enhanced recovery group (n = 35). The primary outcome was the length of hospital stay. Secondary outcomes included the times of removal of nasogastric tubes (NGTs), successful enteral feeding, and removal of drains, postoperative complications, intra-hospital mortality, and rate of readmission.

Results

The mean postoperative hospital stay was 4.49 ± 0.85 days vs. 13.31 ± 6.9 days (P < 0.001), the mean time of removal of NGTs was 0.77 ± 1.031 days vs. 3.26 ± 2.737 days (P < 0.001), the mean time of successful enteral feeding was 1.89 ± 1.13 days vs. 5.46 ± 1.67 days (P < 0.001), and the mean time for removal of intra-abdominal drains was 2.94 ± 1.056 days vs. 9.06 ± 3.757 days (P < 0.001) for the enhanced and the conventional groups, respectively. Complications were significantly lower among patients in the enhanced group (25.7% vs. 65.7%) (P = 0.001). The rates of readmission were similar in the 2 groups.

Conclusion

Applying definite evidence-based elements to the colorectal rehabilitation program significantly boosts the recovery pathway with favorable outcomes, including faster recovery of gastrointestinal tract functions, lower morbidities, and eventually earlier discharge from the hospital.

Citations

Citations to this article as recorded by

Impact of “Enhanced Recovery After Surgery” (ERAS) protocols vs. traditional perioperative care on patient outcomes after colorectal surgery: a systematic review
Vaishnavi Kannan, Najeeb Ullah, Sunitha Geddada, Amir Ibrahiam, Zahraa Munaf Shakir Al-Qassab, Osman Ahmed, Iana Malasevskaia
Patient Safety in Surgery.2025;[Epub] CrossRef
Optimizing Postoperative Recovery in Colorectal Surgery: A Systematic Review on the Efficacy of Enhanced Recovery After Surgery (ERAS) Protocols
Mohey Aldien Ahmed Elamin Elnour, Radwan Alsayed Radwan Ahmed, Ahmed Elkhalifa, Mohamed Eissa Elrayah Omran, Mohamed Ibrahim Osman Hamd, Rouida Elfadil Mohamed Ahmed Aboagla
Cureus.2025;[Epub] CrossRef
Effect of enhanced recovery after surgery protocols on postoperative length of stay and complication rates in elective colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
Ahmad Y. Al-Omari, Rand A. Othman
International Surgery Journal.2025; 12(10): 1745. CrossRef
Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality
Khara M. Sauro, Christine Smith, Seremi Ibadin, Abigail Thomas, Heather Ganshorn, Linda Bakunda, Bishnu Bajgain, Steven P. Bisch, Gregg Nelson
JAMA Network Open.2024; 7(6): e2417310. CrossRef
Effect of rapid rehabilitation nursing on improving clinical outcomes in postoperative patients with colorectal cancer
Jing-Yan Song, Jing Cao, Jian Mao, Jiang-Lian Wang
World Journal of Gastrointestinal Surgery.2024; 16(7): 2119. CrossRef
Pathogenesis, Updates on Current Treatment Options and Alvimopan for Postoperative Ileus
Satish Patil, Swapnil Sharma, Sarvesh Paliwal
Biosciences Biotechnology Research Asia.2023; 20(2): 653. CrossRef
RETRACTED: The effects of enhanced recovery after surgery on wound infection, complications, and postoperative hospital stay in patients undergoing colorectal surgery: A systematic review and meta‐analysis
Nianmei Li, Shuju Wei, Yonghua Qi, Wenjng Wei
International Wound Journal.2023; 20(10): 3990. CrossRef
Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS)
Aya M Riad, Aisling Barry, Stephen R Knight, Carlie J Arbaugh, Parvez D Haque, Thomas G Weiser, Ewen M Harrison
Journal of Global Health.2023;[Epub] CrossRef
Prevention and Management of Postoperative Ileus: A Review of Current Practice
Zeeshan H Khawaja, Ahmed Gendia, Naqqash Adnan, Jamil Ahmed
Cureus.2022;[Epub] CrossRef
Perioperative Care Pathways in Low‐ and Lower‐Middle‐Income Countries: Systematic Review and Narrative Synthesis
Jignesh Patel, Timo Tolppa, Bruce M. Biccard, Brigitta Fazzini, Rashan Haniffa, Debora Marletta, Ramani Moonesinghe, Rupert Pearse, Sutharshan Vengadasalam, Timothy J. Stephens, Cecilia Vindrola‐Padros
World Journal of Surgery.2022; 46(9): 2102. CrossRef
The Prognostic Significance of Lymph Node Status and Lymph Node Ratio (LNR) on Survival of Right Colon Cancer Patients: a Tertiary Center Experience
Mosab Shetiwy, Amr F Elalfy, Osama Eldamshety, Ramy Abbas, Mohamed Abdelkhalek
Journal of Gastrointestinal Cancer.2021; 52(3): 1010. CrossRef
Intraoperative and postoperative complications in colorectal procedures: the role of continuous updating in medicine
Antonello FORGIONE, Salman Y. GURAYA, Michele DIANA, Jacques MARESCAUX
Minerva Surgery.2021;[Epub] CrossRef
The Predictive Value of Pulse Wave Velocity for Anastomotic Leakage After Colorectal Surgery
A. Venara, R. Jaouen, E. Lermite, P. Le Naoures, C. Casa, E. Mirallié, E. Duchalais, A. Hamy
World Journal of Surgery.2019; 43(1): 252. CrossRef
Is the Enhanced Recovery After Surgery (ERAS) Program Effective and Safe in Laparoscopic Colorectal Cancer Surgery? A Meta-Analysis of Randomized Controlled Trials
Xiaofei Ni, Dan Jia, Yan Chen, Lei Wang, Jian Suo
Journal of Gastrointestinal Surgery.2019; 23(7): 1502. CrossRef
The efficacy and safety of enhanced recovery after surgery (ERAS) program in laparoscopic digestive system surgery: A meta-analysis of randomized controlled trials
Xiaofei Ni, Dan Jia, Yuchen Guo, Xuan Sun, Jian Suo
International Journal of Surgery.2019; 69: 108. CrossRef
The Need for Subdividing the Enhanced Recovery Program and Evaluation Criteria After Colorectal Surgery
In Ja Park
Annals of Coloproctology.2017; 33(3): 79. CrossRef

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