Advances in surgical treatment of colorectal cancer based on mesenteric anatomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HAN Wenfeng , LI Shipeng , WEI Hangzhi , ZHANG Xin ,  ZHANG Youcheng

The Second Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730030, P. R. China;

Corresponding author：

ZHANG Youcheng, Email: zhangychmd@126.com

Keywords：

colorectal cancer; total mesorectal excision; complete mesocolic excision; review

DOI：

10.7507/1007-9424.201808026

Video：

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Objective To summarize the progress of surgical treatment of colorectal cancer in recent years from the anatomical features of the mesorectum, aiming to provide a new basis for surgical treatment of colorectal cancer. Method The relevant literatures about total mesorectal excision and complete mesocolic excision in colorectal cancer surgery in recent years were reviewed. Results Total mesorectal excision and complete mesocolic excision significantly reduced the local recurrence rate of patients with colorectal cancer, improved the tumor-free survival rate and overall survival rate, and significantly improved the prognosis of patients, which may benefited from the surgeon’s detailed anatomy of mesenteric plane. In addition, based on current evidence, total mesorectal excision for colorectal cancer was safe and had fewer postoperative complications, which helped to promote the standardization of surgical treatment of colorectal cancer. Conclusions Total mesorectal excision and complete mesocolic excision can significantly improve histopathological prognosis compared with conventional surgery, but the advantages of long-term oncological prognosis need further study. In recent years, the combination of new techniques such as laparoscopy, robotic surgery and natural lumens, and mesenteric resection has provided new directions and new ways for surgical treatment of colorectal cancer.

Citation： HAN Wenfeng, LI Shipeng, WEI Hangzhi, ZHANG Xin, ZHANG Youcheng. Advances in surgical treatment of colorectal cancer based on mesenteric anatomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(2): 241-246. doi: 10.7507/1007-9424.201808026 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	陈功, 任黎, 王屹, 等. 中国临床肿瘤学会 (CSCO) 结直肠癌诊疗指南. 北京: 人民卫生出版社, 2017: 1-4.
3.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence. Br J Surg, 1982, 69(10): 613-616.
4.	Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
5.	Abdelkhalek M, Setit A, Bianco F, et al. Complete mesocolic excision with central vascular ligation in comparison with conventional surgery for patients with colon cancer-the experiences at two centers. Ann Coloproctol, 2018, 34(4): 180-186.
6.	Bernhoff R, Sjövall A, Buchli C, et al. Complete mesocolic excision in right‐sided colon cancer does not increase severe short-term postoperative adverse events. Colorectal Dis, 2018, 20(5): 383-389.
7.	臧潞, 马君俊, 郑民华. 直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响. 中华胃肠外科杂志, 2016, 19(4): 386-387.
8.	Fujii S, Ishibe A, Ota M, et al. Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer. BJS Open, 2018, 2(4): 195-202.
9.	Matsuda K, Yokoyama S, Hotta T, et al. Oncological outcomes following rectal cancer surgery with high or low ligation of the inferior mesenteric artery. Gastrointest Tumors, 2017, 4(1-2): 45-52.
10.	伍颖君, 李民. 保留左结肠动脉应用于腹腔镜低位直肠前切除术的临床研究. 中华胃肠外科杂志, 2017, 20(11): 1313-1315.
11.	尤小兰, 王元杰, 程之逸, 等. 腹腔镜直肠癌全直肠系膜切除术中保留左结肠动脉的临床研究. 中华胃肠外科杂志, 2017, 20(10): 1162-1167.
12.	Chew MH, Yeh YT, Lim E, et al. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf), 2016, 4(3): 173-185.
13.	Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc, 2010, 24(5): 1205-1210.
14.	Penna M, Hompes R, Arnold S, et al. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg, 2017, 266(1): 111-117.
15.	Fernández-Hevia M, Delgado S, Castells A, et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg, 2015, 261(2): 221-227.
16.	Xu W, Xu Z, Cheng H, et al. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: a meta-analysis. Eur J Surg Oncol, 2016, 42(12): 1841-1850.
17.	Meillat H, de Chaisemartin C, Poizat F, et al. Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study. Tech Coloproctol, 2017, 21(1): 43-51.
18.	Lacy AM, Tasende MM, Delgado S, et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg, 2015, 221(2): 415-423.
19.	Tuech JJ, Karoui M, Lelong B, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg, 2015, 261(2): 228-233.
20.	Koedam TW, van Ramshorst GH, Deijen CL, et al. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol, 2017, 21(1): 25-33.
21.	Hu D, Jin P, Hu L, et al. The application of transanal total mesorectal excision for patients with middle and low rectal cancer: A systematic review and meta-analysis. Medicine (Baltimore), 2018, 97(28): e11410.
22.	Bertelsen CA, Bols B, Ingeholm P, et al. Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision. Colorectal Dis, 2011, 13(10): 1123-1129.
23.	Cho MS, Baek SJ, Hur H, et al. Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg, 2015, 261(4): 708-715.
24.	Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol, 2015, 16(2): 161-168.
25.	Merkel S, Weber K, Matzel KE, et al. Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision. Br J Surg, 2016, 103(9): 1220-1229.
26.	Wang C, Gao Z, Shen K, et al. Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Colorectal Dis, 2017, 19(11): 962-972.
27.	Agalianos C, Gouvas N, Dervenis C, et al. Is complete mesocolic excision oncologically superior to conventional surgery for colon cancer? A retrospective comparative study. Ann Gastroenterol, 2017, 30(6): 688-696.
28.	Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg, 2016, 103(5): 581-589.
29.	Bertelsen CA, Neuenschwander AU. The safety of complete mesocolic excision once again confirmed. Colorectal Dis, 2018, 20(6): 552.
30.	Shin JK, Kim HC, Lee WY, et al. Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc, 2018, 32(6): 2721-2731.
31.	Kim MK, Lee IK, Kye BH, et al. Procedural difficulty differences according to tumor location do not compromise the clinical outcome of laparoscopic complete mesocolic excision for colon cancer: a retrospective analysis. Oncotarget, 2017, 8(38): 64509-64519.
32.	Okuda J, Yamamoto M, Tanaka K, et al. Laparoscopic resection of transverse colon cancer at splenic flexure: technical aspects and results. Updates Surg, 2016, 68(1): 71-75.
33.	Wang Y, Zhang C, Feng YF, et al. Comparison of short-term outcomes between laparoscopic-assisted and open complete mesocolic excision (CME) for the treatment of transverse colon cancer. Chin Clin Oncol, 2017, 6(1): 6.
34.	Athanasiou CD, Markides GA, Kotb A, et al. Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Colorectal Dis, 2016, 18(7): O224-O235.
35.	Yoo BE, Cho JS, Shin JW, et al. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol, 2015, 22(4): 1219-1225.
36.	Yang SX, Sun ZQ, Zhou QB, et al. Security and radical assessment in open, laparoscopic, robotic colorectal cancer surgery: a comparative study. Technol Cancer Res Treat, 2018, 17: 1533033818794160.
37.	Widmar M, Keskin M, Strombom P, et al. Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches. Colorectal Dis, 2017, 19(10): 888-894.
38.	Kim JC, Lee JL, Kim CW. Comparative analysis of robot-assisted vs open abdominoperineal resection in terms of operative and initial oncological outcomes. Ann Surg Treat Res, 2018, 95(1): 37-44.
39.	Wilder FG, Burnett A, Oliver J, et al. Erratum to: a review of the long-term oncologic outcomes of robotic surgery versus laparoscopic surgery for colorectal cancer. Indian J Surg, 2016, 78(3): 220.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 陈功, 任黎, 王屹, 等. 中国临床肿瘤学会 (CSCO) 结直肠癌诊疗指南. 北京: 人民卫生出版社, 2017: 1-4.
3. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence. Br J Surg, 1982, 69(10): 613-616.
4. Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis, 2009, 11(4): 354-364.
5. Abdelkhalek M, Setit A, Bianco F, et al. Complete mesocolic excision with central vascular ligation in comparison with conventional surgery for patients with colon cancer-the experiences at two centers. Ann Coloproctol, 2018, 34(4): 180-186.
6. Bernhoff R, Sjövall A, Buchli C, et al. Complete mesocolic excision in right‐sided colon cancer does not increase severe short-term postoperative adverse events. Colorectal Dis, 2018, 20(5): 383-389.
7. 臧潞, 马君俊, 郑民华. 直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响. 中华胃肠外科杂志, 2016, 19(4): 386-387.
8. Fujii S, Ishibe A, Ota M, et al. Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer. BJS Open, 2018, 2(4): 195-202.
9. Matsuda K, Yokoyama S, Hotta T, et al. Oncological outcomes following rectal cancer surgery with high or low ligation of the inferior mesenteric artery. Gastrointest Tumors, 2017, 4(1-2): 45-52.
10. 伍颖君, 李民. 保留左结肠动脉应用于腹腔镜低位直肠前切除术的临床研究. 中华胃肠外科杂志, 2017, 20(11): 1313-1315.
11. 尤小兰, 王元杰, 程之逸, 等. 腹腔镜直肠癌全直肠系膜切除术中保留左结肠动脉的临床研究. 中华胃肠外科杂志, 2017, 20(10): 1162-1167.
12. Chew MH, Yeh YT, Lim E, et al. Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep (Oxf), 2016, 4(3): 173-185.
13. Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc, 2010, 24(5): 1205-1210.
14. Penna M, Hompes R, Arnold S, et al. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg, 2017, 266(1): 111-117.
15. Fernández-Hevia M, Delgado S, Castells A, et al. Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg, 2015, 261(2): 221-227.
16. Xu W, Xu Z, Cheng H, et al. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: a meta-analysis. Eur J Surg Oncol, 2016, 42(12): 1841-1850.
17. Meillat H, de Chaisemartin C, Poizat F, et al. Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study. Tech Coloproctol, 2017, 21(1): 43-51.
18. Lacy AM, Tasende MM, Delgado S, et al. Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg, 2015, 221(2): 415-423.
19. Tuech JJ, Karoui M, Lelong B, et al. A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg, 2015, 261(2): 228-233.
20. Koedam TW, van Ramshorst GH, Deijen CL, et al. Transanal total mesorectal excision (TaTME) for rectal cancer: effects on patient-reported quality of life and functional outcome. Tech Coloproctol, 2017, 21(1): 25-33.
21. Hu D, Jin P, Hu L, et al. The application of transanal total mesorectal excision for patients with middle and low rectal cancer: A systematic review and meta-analysis. Medicine (Baltimore), 2018, 97(28): e11410.
22. Bertelsen CA, Bols B, Ingeholm P, et al. Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision. Colorectal Dis, 2011, 13(10): 1123-1129.
23. Cho MS, Baek SJ, Hur H, et al. Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg, 2015, 261(4): 708-715.
24. Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol, 2015, 16(2): 161-168.
25. Merkel S, Weber K, Matzel KE, et al. Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision. Br J Surg, 2016, 103(9): 1220-1229.
26. Wang C, Gao Z, Shen K, et al. Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Colorectal Dis, 2017, 19(11): 962-972.
27. Agalianos C, Gouvas N, Dervenis C, et al. Is complete mesocolic excision oncologically superior to conventional surgery for colon cancer? A retrospective comparative study. Ann Gastroenterol, 2017, 30(6): 688-696.
28. Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Short-term outcomes after complete mesocolic excision compared with ‘conventional’ colonic cancer surgery. Br J Surg, 2016, 103(5): 581-589.
29. Bertelsen CA, Neuenschwander AU. The safety of complete mesocolic excision once again confirmed. Colorectal Dis, 2018, 20(6): 552.
30. Shin JK, Kim HC, Lee WY, et al. Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc, 2018, 32(6): 2721-2731.
31. Kim MK, Lee IK, Kye BH, et al. Procedural difficulty differences according to tumor location do not compromise the clinical outcome of laparoscopic complete mesocolic excision for colon cancer: a retrospective analysis. Oncotarget, 2017, 8(38): 64509-64519.
32. Okuda J, Yamamoto M, Tanaka K, et al. Laparoscopic resection of transverse colon cancer at splenic flexure: technical aspects and results. Updates Surg, 2016, 68(1): 71-75.
33. Wang Y, Zhang C, Feng YF, et al. Comparison of short-term outcomes between laparoscopic-assisted and open complete mesocolic excision (CME) for the treatment of transverse colon cancer. Chin Clin Oncol, 2017, 6(1): 6.
34. Athanasiou CD, Markides GA, Kotb A, et al. Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Colorectal Dis, 2016, 18(7): O224-O235.
35. Yoo BE, Cho JS, Shin JW, et al. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol, 2015, 22(4): 1219-1225.
36. Yang SX, Sun ZQ, Zhou QB, et al. Security and radical assessment in open, laparoscopic, robotic colorectal cancer surgery: a comparative study. Technol Cancer Res Treat, 2018, 17: 1533033818794160.
37. Widmar M, Keskin M, Strombom P, et al. Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches. Colorectal Dis, 2017, 19(10): 888-894.
38. Kim JC, Lee JL, Kim CW. Comparative analysis of robot-assisted vs open abdominoperineal resection in terms of operative and initial oncological outcomes. Ann Surg Treat Res, 2018, 95(1): 37-44.
39. Wilder FG, Burnett A, Oliver J, et al. Erratum to: a review of the long-term oncologic outcomes of robotic surgery versus laparoscopic surgery for colorectal cancer. Indian J Surg, 2016, 78(3): 220.

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Advances in surgical treatment of colorectal cancer based on mesenteric anatomy

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