EP125 - Conventional Right Colectomy versus Complete Mesocolic Excision and Disease-free survival : A Prospective Cohort Study

Saturday, May 10, 2025

3:25 PM – 3:30 PM PT

Location: Monitor 4, Sails Pavilion, Upper Level

ePoster Presenter(s)

Rodrigo de Almeida Leite, MD, MSc (he/him/his)

Research Fellow, Colon & Rectal Surgery Department
Massachusetts General Hospital
Boston, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

FT

Francisco Tustumi, MD, PHD

Surgeon
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
RP

Rafael Pandini, MD, MSc

Surgeon
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
LG

Lucas Gerbasi, MD

Surgeon
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
AP

Ana Sarah Portilho, MD

Surgeon
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
LH

Lucas Horcel, MD

Surgeon
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
VS

Victor Seid, MD, PHD

Surgeon
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
LR

Lucas Ramos, n/a

Medical Student
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
SS

Sofia Chaves Skaf, n/a

Medical Student
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
LC

Luiz Eduardo Calil de Assumpção, n/a

Medical Student
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

Disclosure information not submitted.
Rocco R. Ricciardi, MD

Chief, Section of Colon and Rectal Surgery
Massachusetts General Hospital
Boston, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

SA

Sergio Eduardo Araujo, MD, PHD

Staff Colon & Rectal Surgeon
Hospital Israelita Albert Einstein
Sao Paulo, Sao Paulo, Brazil

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Rodrigo de Almeida Leite, MD, MSc: This individual has no financial relationships with ineligible companies.

Rocco R. Ricciardi, MD: This individual has no financial relationships with ineligible companies.

Sergio Eduardo Araujo, MD, PHD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Complete mesocolic excision (CME) may be associated with lower rates of nodal recurrence in right colectomy for colon adenocarcinoma. The aim of this study was to compare conventional right colectomy versus CME for right-sided colon adenocarcinoma. A prospective cohort study was conducted Hospital Israelita Albert Einstein, São Paulo, Brazil.

Methods/Interventions: Adult patients (>18 years) diagnosed with right-sided colon adenocarcinoma were included. Only minimally invasive right colectomies (either laparoscopic or robotic) were considered. The inclusion period was from 2019 to 2024. CME was defined as right colectomy with central ligation of the ileocolic artery, right colic artery, and right branch of the colic arteries; mesenteric dissection through the embryological plane; and D3 lymphadenectomy.

Our primary outcome was loco-regional recurrence, defined as nodal disease or local recurrence after the initiation of cancer follow-up. Disease-free survival (DFS) was defined as the absence of loco-regional or distant recurrence after surgery. We performed a survival analysis for DFS and used multivariable Poisson regression to calculate adjusted risk ratios (RR) for loco-regional recurrence between the groups, adjusting for the following factors:

Age;
Sex;
Body mass index (BMI);
Pathological T stage;
Pathological N stage;
Mismatch repair protein deficiency;
Neoadjuvant chemotherapy;
Adjuvant chemotherapy;
First postoperative CEA level;
Hypertension;
Diabetes Mellitus;
ASA score.

Results/Outcomes: A total of 154 cases were included for analysis, 26 in the CME cohort and 128 in the conventional cohort. No local recurrences were observed in either group. Nodal recurrence was observed in 6 patients in the conventional cohort (incidence of 9.52%). No nodal recurrences were observed in the CME group. The mean time to nodal recurrence was 28 months (SD 10 months). The main predictors of nodal recurrence were pT4 and pN2 stages.

After adjusting for multiple confounders, CME was associated with a significantly reduced risk of nodal recurrence (adjusted RR = 0.08; 95% CI: 0.05 to 0.09; p < 0.001) and a significant increase in disease-free survival (HR = 0.03; 95% CI: 0.003 to 0.27; p = 0.002). CME procedure was generally safe, without significant increase in adverse events or length of stay. CME was associated with a significant increase in operative time, with a median increase of 40 minutes.

Conclusion/Discussion: In this prospective cohort study, Complete Mesocolic Excision was associated with decreased nodal recurrence, increased disease-free survival, without higher risk of adverse events.