Retrospective Study Indicates Improved Disease-Free Survival for Complete Mesocolic Excision vs Conventional Surgery for Colon Cancer
In a Danish retrospective population-based study reported in The Lancet Oncology, Bertelsen et al found that complete mesocolic excision resulted in better disease-free survival compared with conventional colon resection in patients with stage I to III colon cancer.
Study Details
The study involved data from all patients undergoing elective resection for Union for International Cancer Control stage I to III colon adenocarcinomas in the Capital Region of Denmark between June 2008 and December 2011. The complete mesocolic excision group consisted of 364 patients who underwent surgery in a center validated to perform the procedure; the control group consisted of 1,031 patients undergoing conventional colon resection in three other hospitals. Overall, 55 complete mesocolic excision patients (15%) and 167 conventional colon resection patients (16%) had stage I disease, 169 (46%) and 499 (48%) had stage II disease, and 140 (38%) and 365 (35%) had stage III disease.
Improved Disease-Free Survival
Four-year disease-free survival was 85.8% among all patients in the complete mesocolic excision group vs 75.9% among all patients in the conventional colon resection group (P = .0010), including rates of 100% vs 89.8% (P = .046) among patients with stage I disease, 91.9% vs 77.9% (P = .0033) among those with stage II disease, and 73.5% vs 67.5% (P = .13) among those with stage III disease.
On multivariate analysis, complete mesocolic excision was an independent predictor of improved disease-free survival among all patients (hazard ratio [HR] = 0.59, P = .0025), those with stage II disease (HR = 0.44, P = .018), and those with stage III disease (HR = 0.64, P = .048). Analysis including propensity score matching showed that 4-year disease-free survival remained significantly higher with complete mesocolic excision (85.8% vs 73.4%, P = .0014).
The investigators concluded: “Our data indicate that [complete mesocolic excision] surgery is associated with better disease-free survival than is conventional colon cancer resection for patients with stage I–III colon adenocarcinoma. Implementation of [complete mesocolic excision] surgery might improve outcomes for patients with colon cancer.”
Claus Anders Bertelsen, MD, of Hillerød University Hospital, is the corresponding author for The Lancet Oncology article.
The study was funded by Tvergaards Fund and Edgar and Hustru Gilberte Schnohrs Fund. The authors declared no competing interests
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