Complete Mesocolic Excision Versus Standard Laparoscopic Colectomy in Right-Sided Colon Cancer: Analysis of Short-Term Results from a Single Italian Center

Background: Laparoscopic complete mesocolic excision (CME) right hemicolectomy is considered a demanding procedure and it is actually adopted in few centers from the West. The aim of the present study is to analyze the safety of laparoscopic CME right hemicolectomy and to compare its short-term results with standard right hemicolectomy in a single Western center. Materials and Methods: Prospectively collected data from 59 patients who underwent laparoscopic CME right hemicolectomy between September 2014 and February 2019 were retrospectively analyzed and compared with data from 55 patients submitted to standard laparoscopic right hemicolectomy between April 2013 and February 2019. Results: No differences were observed between CME and standard right hemicolectomy groups in terms of clinical characteristics. In the CME group, 37.3% of patients were ≥75 years old, 30.5% of patients were ASA class 3, 49.2% of patients had ≥2 comorbidities, 32.2% of patients had a BMI >28 and 13.6% of patients had ≥2 previous abdominal surgeries. No differences were observed in terms of duration of surgery (217±58min vs. 209±56min; P=0.456), intraoperative complications (5.1% vs. 3.6%; P=1) and blood loss (54±48mL Vs 75±63mL, P=0.089). between CME and S group. The percentage of overall (40.7% vs. 49.1%; P=0.451) and severe (Clavien-Dindo ≥3) complications (10.1% vs. 9.1%; P=0.862), redo surgery (5.1% vs. 7.3%; P=0.710) and readmission (5.1% vs. 5.5%; P=1) was comparable between CME group and S group. A significant difference was observed in the length of specimen (334±81mm vs. 273±95mm; P<0.001) as well as in the length of proximal (159±93mm vs.121±71mm; P=0.018) and distal margins (140±67mm vs.113±68mm; P=0.037) in favor of the CME group. The mean±SD number of lymph nodes harvested was higher in the CME group (26.6±11 vs. 21.7±9.2; P=0.011), as it was the percentage of cases with 12 or more retrieved lymph nodes (98.3% vs. 92.7%; P=0.195) though the difference did not reach statistical significance. Conclusions: This study demonstrated the safety of laparoscopic CME right hemicolectomy in a Western series. CME technique showed comparable short-term results and better quality specimens when compared with the standard procedure.