Short-term outcomes after complete mesocolic excision compared with conventional' colonic cancer surgery

BackgroundComplete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with conventional' surgery, but there is a potential for higher morbidity. MethodsData for patients after elective resection at the four centres in the Capital Region of Denmark (June 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study). ResultsSome 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing conventional' resection at the other three hospitals. Laparoscopic CME was performed in 258 (488 per cent) and laparoscopic conventional' resection in 1172 (689 per cent). More extended right colectomy procedures were done in the CME group (174 versus 36 per cent). The 90-day mortality rate in the CME group was 62 per cent versus 49 per cent in the conventional' group (P=0219), with a propensity score-adjusted logistic regression odds ratio (OR) of 122 (95 per cent c.i. 079 to 187). Laparoscopic surgery was associated with a lower risk of mortality at 90days (OR 063, 042 to 095). Intraoperative injury to other organs was more common in CME operations (91 per cent versus 36 per cent for conventional' resection; P<0001), including more splenic (32 versus 12 per cent; P=0004) and superior mesenteric vein (17 versus 02 per cent; P<0001) injuries. Rates of sepsis with vasopressor requirement (66 versus 32 per cent; P=0001) and postoperative respiratory failure (81 versus 34 per cent; P<0001) were higher in the CME group. ConclusionCME is associated with more intraoperative organ injuries and severe non-surgical complications than conventional' resection for colonic cancer. More operative injuries and postoperative sepsis