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Randomized group of patients receiving laparoscopic colectomy with the concept of complete mesocolic excision

Randomized group of patients receiving laparoscopic colectomy with D3-resection

laparoscopic complete mesocolic excision would be applied on randomized group of patients suffering colon cancer and possessing no marked surgical anti-indications. Lap.CME facilitaes medial approach to complete the procedure. CME and HMA are the two arms of the medial approach utilized.

laparoscopic complete mesocolic excision

D3-laparoscopic colectomy would be applied on randomized group of patients suffering colon cancer and possessing no marked surgical anti-indications.

D3-laparoscopic colectomy

Bo Feng, MD/PhD

Laparoscopic complete mesocolic excision is a concept that using laparoscopic surgery technique to perform a resection for colon cancer. Besides, the segment of the colon containing the tumor, the resection area should include an intact mesocolon as an envelope to encase the possible route for metastasis. The routes include blood vessels, lymphatic drain and etc. Such hypothesis predicts better histopathological and higher oncological results which turns into better survival rate and better quality of life.

Laparoscopic Complete Mesocolic Excision on Colon Cancer

Clinical Research on the Efficacy and Feasibility of Laparoscopic Complete Mesocolic Excision on Colon Cancer: A Randomized Controlled Study

The follow up to the patients after the surgery to evaluate the oncological results of the technique

Bo Feng

Research chair of MIS

Randomized group of patients receiving laparoscopic colectomy with the concept of complete mesocolic excision

laparoscopic complete mesocolic excision: laparoscopic complete mesocolic excision would be applied on randomized group of patients suffering colon cancer and possessing no marked surgical anti-indications. Lap.CME facilitaes medial approach to complete the procedure. CME and HMA are the two arms of the medial approach utilized.

Laparoscopic Complete Mesocolic Excision

Randomized group of patients receiving laparoscopic colectomy with D3-resection

D3-laparoscopic colectomy: D3-laparoscopic colectomy would be applied on randomized group of patients suffering colon cancer and possessing no marked surgical anti-indications.

D3 Laparoscopic Colectomy

Total

Age, Categorical

Sex: Female, Male

China

Region of Enrollment

Dr. Bo Feng

Histopathological Outcomes Obtained Through the Surgeries

Survival Rate

Overall Study

Neoplasms

Digestive System Diseases

Colonic Neoplasms

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

All patients with operable colon cancer who will undergo laparoscopic conventional colectomy

All patients with operable colon cancer who will undergo laparoscopic complete mesocolic excision

Laparoscopic colectomy with only lymph node dissection up to level 2 lymph nodes D2.

laparoscopic conventional colectomy

Laparoscopic colectomy with lymphovascular dissection from level 3 lymph nodes or more D3.

Ahmed E Ahmed, Professor

Mena Z Helmy, Ass prof.

Mostafa F Mohammed, Ass lecturer

The investigators will assess and compare Surgical, pathological and oncological outcomes between two laparoscopic procedures conventional colectomy versus complete mesocolic excision for operable colon cancer cases in Upper Egypt

Colon cancer is considered a huge clinical surgical burden accounting for 10% of cancer cases and deaths all over the world with consideration that surgery and adjuvant chemotherapy(if indicated) are the main lines of treatment .

When Werner Hohenberger and colleagues described complete mesocolic excision (CME) in 2009; resection along the embryological and lymphovascular planes with appropriate resection margins, they did it for years before describing it with suggestion of improved disease outcomes and overall survival compared to the conventional colectomy (CC).

The principles of CME were described after the significant improvement of rectal adenocarcinoma surgical outcomes with establishment of total mesorectal excision (TME) in which tumor resection is associated with dissection of mesorectal fascial embryologic and lymphovascular planes.

CME includes the same principles of the CC with maximizing lymph node dissection level into (D3 extended lymphadenectomy instead of D1 and D2 in conventional colectomy) and central vascular ligation (CVL) of the main feeding vessel(s) at their origin, with suggested improved disease-free and overall survival with suggested superior pathological and oncological results in the specimen.

Some surgeons consider that CME; with D3 extended lymphadenectomy and CVL is the optimal or standard surgical method in primary cancer colon based on suggested reduced local recurrence and improved disease-free and overall survival.

Although CME has a theoretical advantages and promising early results, it is not widely adopted as the standard in some areas. CME is technically more demanding than CC and suggested to be associated with more intraoperative visceral injuries and non-surgical complications and many doubts persist about safety and efficacy of the procedure.

The questions of interest and research, should CME be regarded as the optimal procedure for colon cancer cases? And also another question; is conventional colectomy suboptimal?

Comparison Between Results of 2 Laparoscopic Surgical Procedures in Operable Colon Cancer Cases in Upper Egypt

Surgical, Pathological and Oncological Outcomes of Laparoscopic Conventional Colectomy Versus Complete Mesocolic Excision for Operable Colon Cancer Cases in Upper Egypt

It is not yet known if there will be a plan to make IPD available.

Histopathological examination of the resected colon with lymph node status and number

Amount in cubic cm and nature of it with its management

Yes/No with Reporting the postoperative complications; according to the Clavien-Dindo Grading System

Reporting operative time with measurements in minutes

Yes/No with measurement in Cubic Cm and how managed

According to primary tumor, regional nodes, metastasis (TNM) staging system

Reporting Yes/No with amount in cm3 and management

Carcinoembryonic antigen (CEA) level by ng/mL

Type of anastomosis (intra- or extracorporeal)

cecum, appendix, ascending colon, hepatic flexure or at splenic flexure, transverse and descending colon and sigmoid colon

Yes/No Cardiopulmonary complications type and how managed

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Laparoscopic Complete Mesocolic Excision on Colon Cancer	NCT01628250	Operation Findi... Complications Pathology Quality of Life Neoplasms Recur...	laparoscopic co... D3-laparoscopic...	18 Years - 79 Years	Ruijin Hospital
Laparoscopic Complete Mesocolic Excision on Colon Cancer	NCT01628250	Operation Findi... Complications Pathology Quality of Life Neoplasms Recur...	laparoscopic co... D3-laparoscopic...	18 Years - 79 Years	Ruijin Hospital
Comparison Between Results of 2 Laparoscopic Surgical Procedures in Operable Colon Cancer Cases in Upper Egypt	NCT05421702	Colon Cancer St... Colon Cancer St...	laparoscopic co... laparoscopic co...	-	Sohag University

Spots Global Cancer Trial Database for laparoscopic complete mesocolic excision