The Implications of Complete Mesocolic Excision in the Treatment of Patients with Potentially Curable Colorectal Cancer Stage III

Abstract
Background: Complete mesocolic excision and central vascular ligation remove more mesocolon and are best able to completely remove lymph node metastases in the draining area raising a question, does it really improve the outcome compared to an incomplete or damaged excision of the me-sentery.
Aim of the Work: To determine the drawbacks of total mesocolic excision on the number of total LNs harvested, overall survival and disease specific survival of Patients with Potentially Curable Colorectal Cancer Stage III.
Patients and Methods: It is a randomized control study and it's managed and followed-up in the police authority hospital between January 2014 and August 2015 (20 months), comparing it with a retrospective cohort (control) study of 55 patients that was analyzed in the previous study.
Twenty five patients with colon cancer stage III were included in the study with complete open resection of the primary tumour with lymphovascular resection as much as possible (complete mesocolic excision) to see its reflection on prognosis and follow-up of these patients for 18 months regarding survival rate, local recurrences, metastasis.
Results: The total number of harvested nodes was (505) LNs mean was 20.2±6.6 (range 12-35, median 19 nodes). The total number of the positive LN was 129; its mean was 5.1±2 (range 1-9, median 5). The number of patients with N1 was 6 (24%), with N2a was 13 (52%) and with N2b was 6 (24%). The lymph node ratio ranged from 8.3% to 53.3% (mean 27.3±13.2, median 25).
Comparing the 1.5 year overall and disease specific survival in colon cancer in both retrospective(control group) and prospective group revealed a better outcome in the pro-spective group in both OS and DSS (96%) vs. (OS of 93.1%, DSS of 90.9%) in retrospective group, but it didn't reach a significance (p=0.61) in OS and (p=0.43) in DSS.
Conclusion: Extended lymphadenectomy in colon cancer is important and should be applied universally for several reasons as Tumor staging would be more precise and con-founding stage migration is avoided.