Laparoscopic complete mesocolic excision with central vascular ligation in 600 right total mesocolectomies: Safety, prognostic factors and oncologic outcome

Background: To analyze our experience with laparoscopic right Mesocolectomy in right colonic cancers. Methods: 600 consecutive patients were studied. Results: Mortality was 0.5%; morbidity was 35.5%. Mean mesocolic area was 15339 +/- 1639 mm(3), specimen length 24.3 +/- 3.3 cm, distance from the tumor to high tie was 103 +/- 6 mm and mean lymph nodes harvested was 27 +/- 3; mesocolic plane was achieved in 81% of cases. Survival was 83%; stratified survival in patients with stage II, IIIA/B and in the subgroup of stage IIIC patients with negative apical nodes was 88.7%, 72.4%, 71.4% respectively; stage IIIC patients with positive apical nodes showed poor survival (27.7%). Recurrence occurred in 177 patients (29.5%) and was mainly systemic (22.7%). At the multivariate analysis, "non mesocolic" plane of resection, positive N3 apical nodes and CEA levels > 5 ng/dL were found to be independent prognostic factors. Conclusions: Laparoscopic right Mesocolectomy showed to be safe and yielded surgical specimens of high quality, with impact on survival; positive N3 apical nodes and "non mesocolic" planes were independently associated to poor outcome. (C) 2016 Elsevier Inc. All rights reserved.