Excisão Completa do Mesocólon - Revisão da literatura

  • Carla Carneiro Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
  • Ricardo Rocha Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
  • Rui Marinho Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
  • António Gomes Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
  • Carlos Leichsenring Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
  • Vasco Geraldes Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
  • Vitor Nunes Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.

Resumo

Desde a descrição da Excisão Total do Mesorreto (TME), a taxa de recidiva local da neoplasia do recto desceu de 20 a 40% para cerca de 10%(1,2). É neste contexto, que Hohenberger descreve em 2008 a Excisão Completa do Mesocólon (Complete Mesocolic Excision, CME)(3). Trata-se de uma técnica cirúrgica mais radical, tendo como base teórica e conceptual os mesmos princípios descritos por Heald para a TME. Com a CME estão descritas taxa de recidiva locorregional de 3,6% e sobrevida global aos 5 anos de 89%, resultados substancialmente melhores que os relatados na literatura utilizando a técnica convencional. Foi efetuada uma revisão da literatura com o termo “Complete Mesocolic Excision”, utilizando a base de dados pubMed, sem restrição temporal. Analisamos 52 artigos, quanto a questões referentes à técnica e anatomia cirúrgica, complicações da técnica, avaliação morfológica do espécime cirúrgico; resultados oncológicos medidos como recidiva e sobrevida global, reprodutibilidade da cirurgia e seus resultados noutros centros e na abordagem laparoscópica. A CME é uma técnica promissora, estandardizada, com resultados oncológicos superiores, sem maior taxa de complicações cirúrgicas.

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Biografias Autor

Carla Carneiro, Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
Assistente Cirurgia Geral
Ricardo Rocha, Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
Interno de Formação Específica Cirurgia Geral
Rui Marinho, Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.

Interno de Formação Específica Cirurgia Geral

António Gomes, Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
Assistente Cirurgia Geral
Carlos Leichsenring, Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
Assistente Cirurgia Geral
Vasco Geraldes, Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.
Assistente Graduado Cirurgia Geral
Vitor Nunes, Serviço de Cirurgia B - Hospital Prof.Dr. Fernando Fonseca E.P.E.

Assistente Graduado Sénior Cirurgia Geral

Director de Serviço

Referências

1. Heald R, Husband E, Ryall R. The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg. 1982;(69):613-6.
2. Joern F, Gunter H, Thomas J, Erik P, Jörg Z, Dorothea B, et al. Outcome for stage II and III rectal and colon cancer equally good after treatment improvement over three decades. Int J Colorectal Dis. Springer Verlag; 2015;30(6):797-806.
3. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: Complete mesocolic excision and central ligation – Technical notes and outcome. Color Dis. 2009;11(4):354-64.
4. Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: A retrospective, population-based study. Lancet Oncol. Lancet Publishing Group; 2015;16(2):161-8.
5. Liang JT, Lai HS, Huang J, Sun CT. Long-term oncologic results of laparoscopic D3 lymphadenectomy with complete mesocolic excision for right-sided colon cancer with clinically positive lymph nodes. Surg Endosc Other Interv Tech. Springer New York LLC; 2015;29(8):2394-401.
6. SF T. Lectures on the anatomy of the intestinal canal and peritoneum in man. Br Med J. 1885;1:415.
7. Sehgal R, Coffey JC. Historical development of mesenteric anatomy provides a universally applicable anatomic paradigm for complete/ total mesocolic excision. Gastroenterol Rep [Internet]. 2014;2(4):245-50. Available from: http://gastro.oxfordjournals.org/cgi/doi/10.1093/ gastro/gou046
8. Coffey JC, Sehgal R, Culligan K, Dunne C, McGrath D, Lawes N, et al. Terminology and nomenclature in colonic surgery: Universal application of a rule-based approach derived from updates on mesenteric anatomy. Techniques in Coloproctology. Springer-Verlag Italia s.r.l.; 2014. p. 789-94.
9. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery – the clue to pelvic recurrence? Br J Surg. 1982;69(10):613-6.
10. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28(2):272-8.
11. Goligher JC. Incidence and pathology of carcinoma of the colon and rectum. In: JC G, editor. Surgery of the Anus, Rectum and Colon. 5th ed. London: Baillie`re Tindall; 1984. p. 445.
12. Toyota S, Ohta H, Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum. Springer-Verlag; 199 5;38(7):705-11.
13. Hohenberger, W., Merkel S. WK. Lymphadenektomie bei Tumoren des unteren Gastrointestinaltrakts. Chirurg. 2007;(78):217-25.
14. Van Damme J-P BJ. The more exceptional right colic artery. Vascular Anatomy in Abdominal Surgery. New York: Georg Thieme, Stuttgart; 199 0. p. 53.
15. Perrakis A, Weber K, Merkel S, Matzel K, Agaimy A, Gebbert C, et al. Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Colorectal Dis. 2014;29(10):1223-9.
16. Willaert W, Ceelen W. Extent of surgery in cancer of the colon: Is more better? World J Gastroenterol. WJG Press; 2015;21(1):132-8.
17. Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G, et al. Evidence based medicine and surgical approaches for colon cancer: Evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol. WJG Press; 2014;20(13):3680-92.
18. Storli KE, S??ndenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I, et al. Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol. Springer-Verlag Italia s.r.l.; 2014;18(6):557-64.
19. Killeen S, Mannion M, Devaney A, Winter DC. Complete mesocolic resection and extended lymphadenectomy for colon cancer: A systematic review. Color Dis. Blackwell Publishing Ltd; 2014;16(8):577-94.
20. Nagtegaal ID, van de Velde CJH, van der Worp E, Kapiteijn E, Quirke P, van Krieken JHJM. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2002.
21. West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9(9):857-65.
22. Kobayashi H, West NP, Takahashi K, Perrakis A, Weber K, Hohenberger W, et al. Quality of surgery for stage III colon cancer: comparison between England, Germany, and Japan. Ann Surg Oncol [Internet]. 2014;21 Suppl 3(October 2013):S398-404. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24566862
23. American Society of Cancer [Internet]. Available from: http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/ colorectal-cancer-survival-rates
24. Pramateftakis MG. Optimizing colonic cancer surgery: High ligation and complete mesocolic excision during right hemicolectomy. Tech Coloproctol. Springer-Verlag Italia s.r.l.; 2010;14(SUPPL. 1).
25. Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J. Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg. 2011;98(8):1171-8.
26. West NP, Kennedy RH, Magro T, Luglio G, Sala S, Jenkins JT, et al. Morphometric analysis and lymph node yield in laparoscopic complete mesocolic excision performed by supervised trainees. Br J Surg. John Wiley and Sons Ltd; 2014;101(11):1460-7.
27. Melich G, Jeong DH, Hur H, Baik SH, Faria J, Kim NK, et al. Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy – Analysis of learning curves for a novice minimally invasive surgeon. Can J Surg. Canadian Medical Association; 2014;57(5):331-6.
28. Shin JW, Amar AHY, Kim SH, Kwak JM, Baek SJ, Cho JS, et al. Complete mesocolic excision with D3 lymph node dissection in laparoscopic colectomy for stages II and III colon cancer: Long-term oncologic outcomes in 168 patients. Tech Coloproctol. Springer-Verlag Italia s.r.l.; 2014;18(9):795-803.
29. Kontovounisios C, Kinross J, Tan E, Brown G, Rasheed S, Tekkis P. Complete mesocolic excision in colorectal cancer: A systematic review. Color Dis. Blackwell Publishing Ltd; 2015;17(1):7-16.
30. Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, Brown G, Tudyka V, D’Hoore A, Kennedy RH, West NP, Kim SH, Heald R, Storli KE, Nesbakken A, Moran B. The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery : proceedings of a consensus conference. Int J Colorectal Dis. 2014 Apr;29(4): 419-28.
31. Ogino T, Takemasa I, Horitsugi G, Furuyashiki M, Ohta K, Uemura M, Nishimura J, Hata T, Mizushima T, Yamamoto H, Doki Y, Mori M. Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer. Ann Surg Oncol. 2014 Jun;21 Suppl 3:S429-35.
32. Sehgal R, Coffey JC. Standardization of the nomenclature based on contemporary mesocolic anatomy is paramount prior to performing a complete mesocolic excision. Int J Colorectal Dis. 2014 Apr;29(4):543-4.
33. Buczacki SJ, Davies RJ. Colon resection: is standard technique adequate? Surg Oncol Clin N Am. 2014 Jan;23(1):25-34.
34. Willaert W, Mareel M, Van De Putte D, Van Nieuwenhove Y, Pattyn P, Ceelen W. Lymphatic spread, nodal count and the extent of lymphadenectomy in cancer of the colon. Cancer Treat Rev. 2014 Apr;40(3):405-13.
35. Storli KE, Søndenaa K, Furnes B, Eide GE. Outcome after introduction of complete mesocolic excision for colon cancer is similar for open and laparoscopic surgical treatments. Dig Surg. 2013;30(4-6):317-27.
36. Galizia G, Lieto E, De Vita F, Ferraraccio F, Zamboli A, Mabilia A, Auricchio A, Castellano P, Napolitano V, Orditura M. Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study. Int J Colorectal Dis. 2014 Jan;29(1):89-97.
37. Gao Z, Ye Y, Zhang W, Shen D, Zhong Y, Jiang K, Yang X, Yin M, Liang B, Tian L, Wang S. An anatomical, histopathological, and molecular biological function study of the fascias posterior to the interperitoneal colon and its associated mesocólon: their relevance to colonic surgery. J Anat. 2013 Aug;223(2):123-32.
38. Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, Ma JJ, Li JW, Zang L, Han DP, Zheng MH. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc. 2012 Dec;26(12):3669-75.
39. Sagap I, Elnaim AL, Hamid I, Rose IM. Surgeons’ Evaluation of Colorectal Cancer Resections Against Standard HPE Protocol-Auditing the Surgeons. Indian J Surg. 2011 Jun;73(3):194-8.
40. Adamina M, Manwaring ML, Park KJ, Delaney CP. Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc. 2012 Oct;26(10):2976-80. Epub 2012 May 2.
41. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012 May 20;30(15):1763-9.
42. Gouvas N, Pechlivanides G, Zervakis N, Kafousi M, Xynos E. Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Colorectal Dis. 2012 Nov;14(11):1357-64.
43. Rosenberg J, Fischer A, Haglind E; Scandinavian Surgical Outcomes Research Group. Current controversies in colorectal surgery: the way to resolve uncertainty and move forward. Colorectal Dis. 2012 Mar;14(3):266-9.
44. Bethune R, Marshall M, Daniels IR. Response to ‘Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Colorectal Dis. 2012 Mar;14(3):389.
45. Siani LM, Pulica C. Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: Long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery. Scand J Surg. Finnish Surgical Society; 2015;104(4):219-26.
46. Chow CFK, Kim SH. Laparoscopic complete mesocolic excision: West meets East. World Journal of Gastroenterology. WJG Press; 2014. p. 14301-7.
47. Açar Hİ, Cömert A, Avşar A, Çelik S, Kuzu MA. Dynamic article: surgical anatomical planes for complete mesocolic excision and applied vascular anatomy of the right colon. Dis Colon Rectum. 2014;57(10):1169-75.
48. Nakajima K, Inomata M, Akagi T, Etoh T, Sugihara K, Watanabe M, et al. Quality control by photo documentation for evaluation of laparoscopic and open colectomy with D3 resection for stage II/III colorectal cancer: Japan clinical oncology group study JCOG 0404. Jpn J Clin Oncol. Oxford University Press; 2014;44(9):799 -806.
49. Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N. Modified Complete Mesocolic Excision With Central Vascular Ligation for the Treatment of Right-Sided Colon Cancer: Long-term Outcomes and Prognostic Factors. Ann Surg. 2014;00(00):1-8.
50. Perrakis A, Weber K, Merkel S, Matzel K, Agaimy A, Gebbert C, et al. Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Colorectal Dis. 2014;29(10):1223-9.
51. Culligan K, Sehgal R, Mulligan D, Dunne C, Walsh S, Quondamatteo F, et al. A detailed appraisal of mesocolic lymphangiology – An immunohistochemical and stereological analysis. J Anat. Blackwell Publishing Ltd; 2014;225(4):463-72.
52. Mori S, Baba K, Yanagi M, Kita Y, Yanagita S, Uchikado Y, et al. Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer. Surg Endosc Other Interv Tech. Springer New York LLC; 2015;29(1):34-40.
53. Munkedal DLE, West NP, Iversen LH, Hagemann-Madsen R, Quirke P, Laurberg S. Implementation of complete mesocolic excision at a university hospital in Denmark: An audit of consecutive, prospectively collected colon cancer specimens. Eur J Surg Oncol. W.B. Saunders Ltd; 2014;40(11):1494-501.
54. Yao H-WH –w., Liu Y-HY –h. Re-examination of the standardization of colon cancer surgery. Gastroenterol Rep. 2013;1(2):113-8.
55. Kang J, Kim IK, Kang SI, Sohn SK, Lee KY. Laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc Other Interv Tech. Springer New York LLC; 2014;28(9):2747-51.
56. Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, et al. Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol [Internet]. 2014;21(7):2288-94.
Publicado
2016-09-30
Como Citar
CARNEIRO, Carla et al. Excisão Completa do Mesocólon - Revisão da literatura. Revista Portuguesa de Cirurgia, [S.l.], n. 38, p. 19 - 29, set. 2016. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/479>. Acesso em: 14 nov. 2019.
Secção
Artigos de Revisão