Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study

Claus Anders Bertelsen; Anders Ulrich Neuenschwander; Jens Erik Jansen; Michael Wilhelmsen; Anders Kirkegaard-Klitbo; Jutaka Reilin Tenma; Birgitte Bols; Peter Ingeholm; Leif Ahrenst Rasmussen; Lars Vedel Jepsen; Else Refsgaard Iversen; Bent Kristensen; Ismail Gögenur; Danish Colorectal Cancer Group

doi:10.1016/S1470-2045(14)71168-4

Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study

Claus Anders Bertelsen, Anders Ulrich Neuenschwander, Jens Erik Jansen, Michael Wilhelmsen, Anders Kirkegaard-Klitbo, Jutaka Reilin Tenma, Birgitte Bols, Peter Ingeholm, Leif Ahrenst Rasmussen, Lars Vedel Jepsen, Else Refsgaard Iversen, Bent Kristensen, Ismail Gögenur, Danish Colorectal Cancer Group

248 Citations (Scopus)

Abstract

BACKGROUND: Application of the principles of total mesorectal excision to colon cancer by undertaking complete mesocolic excision (CME) has been proposed to improve oncological outcomes. We aimed to investigate whether implementation of CME improved disease-free survival compared with conventional colon resection.

METHODS: Data for all patients who underwent elective resection for Union for International Cancer Control (UICC) stage I-III colon adenocarcinomas in the Capital Region of Denmark between June 1, 2008, and Dec 31, 2011, were retrieved for this population-based study. The CME group consisted of patients who underwent CME surgery in a centre validated to perform such surgery; the control group consisted of patients undergoing conventional colon resection in three other hospitals. Data were collected from the Danish Colorectal Cancer Group (DCCG) database and medical charts. Patients were excluded if they had stage IV disease, metachronous colorectal cancer, rectal cancer (≤ 15 cm from anal verge) in the absence of synchronous colon adenocarcinoma, tumour of the appendix, or R2 resections. Survival data were collected on Nov 13, 2014, from the DCCG database, which is continuously updated by the National Central Office of Civil Registration.

FINDINGS: The CME group consisted of 364 patients and the non-CME group consisted of 1031 patients. For all patients, 4-year disease-free survival was 85.8% (95% CI 81.4-90.1) after CME and 75.9% (72.2-79.7) after non-CME surgery (log-rank p=0.0010). 4-year disease-free survival for patients with UICC stage I disease in the CME group was 100% compared with 89.8% (83.1-96.6) in the non-CME group (log-rank p=0.046). For patients with UICC stage II disease, 4-year disease-free survival was 91.9% (95% CI 87.2-96.6) in the CME group compared with 77.9% (71.6-84.1) in the non-CME group (log-rank p=0.0033), and for patients with UICC stage III disease, it was 73.5% (63.6-83.5) in the CME group compared with 67.5% (61.8-73.2) in the non-CME group (log-rank p=0.13). Multivariable Cox regression showed that CME surgery was a significant, independent predictive factor for higher disease-free survival for all patients (hazard ratio 0.59, 95% CI 0.42-0.83), and also for patients with UICC stage II (0.44, 0.23-0.86) and stage III disease (0.64, 0.42-1.00). After propensity score matching, disease-free survival was significantly higher after CME, irrespective of UICC stage, with 4-year disease-free survival of 85.8% (95% CI 81.4-90.1) after CME and 73.4% (66.2-80.6) after non-CME (log-rank p=0·0014).

INTERPRETATION: Our data indicate that CME surgery is associated with better disease-free survival than is conventional colon cancer resection for patients with stage I-III colon adenocarcinoma. Implementation of CME surgery might improve outcomes for patients with colon cancer.

FUNDING: Tvergaards Fund and Edgar and Hustru Gilberte Schnohrs Fund.

Original language	English
Journal	Lancet Oncology
Volume	16
Issue number	2
Pages (from-to)	161-8
Number of pages	8
ISSN	1470-2045
DOIs	https://doi.org/10.1016/S1470-2045(14)71168-4
Publication status	Published - 1 Feb 2015

Keywords

Adenocarcinoma
Adenocarcinoma, Mucinous
Aged
Carcinoma, Medullary
Carcinoma, Signet Ring Cell
Colonic Neoplasms
Denmark
Disease-Free Survival
Female
Follow-Up Studies
Humans
Lymphatic Metastasis
Male
Mesocolon
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Survival Rate
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/S1470-2045(14)71168-4

Cite this

Bertelsen, C. A., Neuenschwander, A. U., Jansen, J. E., Wilhelmsen, M., Kirkegaard-Klitbo, A., Tenma, J. R., Bols, B., Ingeholm, P., Rasmussen, L. A., Jepsen, L. V., Iversen, E. R., Kristensen, B., Gögenur, I., & Danish Colorectal Cancer Group (2015). Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncology, 16(2), 161-8. https://doi.org/10.1016/S1470-2045(14)71168-4

Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery : a retrospective, population-based study. / Bertelsen, Claus Anders; Neuenschwander, Anders Ulrich; Jansen, Jens Erik et al.

In: Lancet Oncology, Vol. 16, No. 2, 01.02.2015, p. 161-8.

Research output: Contribution to journal › Journal article › Research › peer-review

Bertelsen, CA, Neuenschwander, AU, Jansen, JE, Wilhelmsen, M, Kirkegaard-Klitbo, A, Tenma, JR, Bols, B, Ingeholm, P, Rasmussen, LA, Jepsen, LV, Iversen, ER, Kristensen, B, Gögenur, I & Danish Colorectal Cancer Group 2015, 'Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study', Lancet Oncology, vol. 16, no. 2, pp. 161-8. https://doi.org/10.1016/S1470-2045(14)71168-4

@article{c5c8161ed23e495cb73c08ed021c67ad,

title = "Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study",

abstract = "BACKGROUND: Application of the principles of total mesorectal excision to colon cancer by undertaking complete mesocolic excision (CME) has been proposed to improve oncological outcomes. We aimed to investigate whether implementation of CME improved disease-free survival compared with conventional colon resection.METHODS: Data for all patients who underwent elective resection for Union for International Cancer Control (UICC) stage I-III colon adenocarcinomas in the Capital Region of Denmark between June 1, 2008, and Dec 31, 2011, were retrieved for this population-based study. The CME group consisted of patients who underwent CME surgery in a centre validated to perform such surgery; the control group consisted of patients undergoing conventional colon resection in three other hospitals. Data were collected from the Danish Colorectal Cancer Group (DCCG) database and medical charts. Patients were excluded if they had stage IV disease, metachronous colorectal cancer, rectal cancer (≤ 15 cm from anal verge) in the absence of synchronous colon adenocarcinoma, tumour of the appendix, or R2 resections. Survival data were collected on Nov 13, 2014, from the DCCG database, which is continuously updated by the National Central Office of Civil Registration.FINDINGS: The CME group consisted of 364 patients and the non-CME group consisted of 1031 patients. For all patients, 4-year disease-free survival was 85.8% (95% CI 81.4-90.1) after CME and 75.9% (72.2-79.7) after non-CME surgery (log-rank p=0.0010). 4-year disease-free survival for patients with UICC stage I disease in the CME group was 100% compared with 89.8% (83.1-96.6) in the non-CME group (log-rank p=0.046). For patients with UICC stage II disease, 4-year disease-free survival was 91.9% (95% CI 87.2-96.6) in the CME group compared with 77.9% (71.6-84.1) in the non-CME group (log-rank p=0.0033), and for patients with UICC stage III disease, it was 73.5% (63.6-83.5) in the CME group compared with 67.5% (61.8-73.2) in the non-CME group (log-rank p=0.13). Multivariable Cox regression showed that CME surgery was a significant, independent predictive factor for higher disease-free survival for all patients (hazard ratio 0.59, 95% CI 0.42-0.83), and also for patients with UICC stage II (0.44, 0.23-0.86) and stage III disease (0.64, 0.42-1.00). After propensity score matching, disease-free survival was significantly higher after CME, irrespective of UICC stage, with 4-year disease-free survival of 85.8% (95% CI 81.4-90.1) after CME and 73.4% (66.2-80.6) after non-CME (log-rank p=0·0014).INTERPRETATION: Our data indicate that CME surgery is associated with better disease-free survival than is conventional colon cancer resection for patients with stage I-III colon adenocarcinoma. Implementation of CME surgery might improve outcomes for patients with colon cancer.FUNDING: Tvergaards Fund and Edgar and Hustru Gilberte Schnohrs Fund.",

keywords = "Adenocarcinoma, Adenocarcinoma, Mucinous, Aged, Carcinoma, Medullary, Carcinoma, Signet Ring Cell, Colonic Neoplasms, Denmark, Disease-Free Survival, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Male, Mesocolon, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Survival Rate, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't",

author = "Bertelsen, {Claus Anders} and Neuenschwander, {Anders Ulrich} and Jansen, {Jens Erik} and Michael Wilhelmsen and Anders Kirkegaard-Klitbo and Tenma, {Jutaka Reilin} and Birgitte Bols and Peter Ingeholm and Rasmussen, {Leif Ahrenst} and Jepsen, {Lars Vedel} and Iversen, {Else Refsgaard} and Bent Kristensen and Ismail G{\"o}genur and {Danish Colorectal Cancer Group}",

year = "2015",

month = feb,

day = "1",

doi = "10.1016/S1470-2045(14)71168-4",

language = "English",

volume = "16",

pages = "161--8",

journal = "The Lancet Oncology",

issn = "1470-2045",

publisher = "TheLancet Publishing Group",

number = "2",

}

TY - JOUR

T1 - Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery

T2 - a retrospective, population-based study

AU - Bertelsen, Claus Anders

AU - Neuenschwander, Anders Ulrich

AU - Jansen, Jens Erik

AU - Wilhelmsen, Michael

AU - Kirkegaard-Klitbo, Anders

AU - Tenma, Jutaka Reilin

AU - Bols, Birgitte

AU - Ingeholm, Peter

AU - Rasmussen, Leif Ahrenst

AU - Jepsen, Lars Vedel

AU - Iversen, Else Refsgaard

AU - Kristensen, Bent

AU - Gögenur, Ismail

AU - Danish Colorectal Cancer Group

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: Application of the principles of total mesorectal excision to colon cancer by undertaking complete mesocolic excision (CME) has been proposed to improve oncological outcomes. We aimed to investigate whether implementation of CME improved disease-free survival compared with conventional colon resection.METHODS: Data for all patients who underwent elective resection for Union for International Cancer Control (UICC) stage I-III colon adenocarcinomas in the Capital Region of Denmark between June 1, 2008, and Dec 31, 2011, were retrieved for this population-based study. The CME group consisted of patients who underwent CME surgery in a centre validated to perform such surgery; the control group consisted of patients undergoing conventional colon resection in three other hospitals. Data were collected from the Danish Colorectal Cancer Group (DCCG) database and medical charts. Patients were excluded if they had stage IV disease, metachronous colorectal cancer, rectal cancer (≤ 15 cm from anal verge) in the absence of synchronous colon adenocarcinoma, tumour of the appendix, or R2 resections. Survival data were collected on Nov 13, 2014, from the DCCG database, which is continuously updated by the National Central Office of Civil Registration.FINDINGS: The CME group consisted of 364 patients and the non-CME group consisted of 1031 patients. For all patients, 4-year disease-free survival was 85.8% (95% CI 81.4-90.1) after CME and 75.9% (72.2-79.7) after non-CME surgery (log-rank p=0.0010). 4-year disease-free survival for patients with UICC stage I disease in the CME group was 100% compared with 89.8% (83.1-96.6) in the non-CME group (log-rank p=0.046). For patients with UICC stage II disease, 4-year disease-free survival was 91.9% (95% CI 87.2-96.6) in the CME group compared with 77.9% (71.6-84.1) in the non-CME group (log-rank p=0.0033), and for patients with UICC stage III disease, it was 73.5% (63.6-83.5) in the CME group compared with 67.5% (61.8-73.2) in the non-CME group (log-rank p=0.13). Multivariable Cox regression showed that CME surgery was a significant, independent predictive factor for higher disease-free survival for all patients (hazard ratio 0.59, 95% CI 0.42-0.83), and also for patients with UICC stage II (0.44, 0.23-0.86) and stage III disease (0.64, 0.42-1.00). After propensity score matching, disease-free survival was significantly higher after CME, irrespective of UICC stage, with 4-year disease-free survival of 85.8% (95% CI 81.4-90.1) after CME and 73.4% (66.2-80.6) after non-CME (log-rank p=0·0014).INTERPRETATION: Our data indicate that CME surgery is associated with better disease-free survival than is conventional colon cancer resection for patients with stage I-III colon adenocarcinoma. Implementation of CME surgery might improve outcomes for patients with colon cancer.FUNDING: Tvergaards Fund and Edgar and Hustru Gilberte Schnohrs Fund.

AB - BACKGROUND: Application of the principles of total mesorectal excision to colon cancer by undertaking complete mesocolic excision (CME) has been proposed to improve oncological outcomes. We aimed to investigate whether implementation of CME improved disease-free survival compared with conventional colon resection.METHODS: Data for all patients who underwent elective resection for Union for International Cancer Control (UICC) stage I-III colon adenocarcinomas in the Capital Region of Denmark between June 1, 2008, and Dec 31, 2011, were retrieved for this population-based study. The CME group consisted of patients who underwent CME surgery in a centre validated to perform such surgery; the control group consisted of patients undergoing conventional colon resection in three other hospitals. Data were collected from the Danish Colorectal Cancer Group (DCCG) database and medical charts. Patients were excluded if they had stage IV disease, metachronous colorectal cancer, rectal cancer (≤ 15 cm from anal verge) in the absence of synchronous colon adenocarcinoma, tumour of the appendix, or R2 resections. Survival data were collected on Nov 13, 2014, from the DCCG database, which is continuously updated by the National Central Office of Civil Registration.FINDINGS: The CME group consisted of 364 patients and the non-CME group consisted of 1031 patients. For all patients, 4-year disease-free survival was 85.8% (95% CI 81.4-90.1) after CME and 75.9% (72.2-79.7) after non-CME surgery (log-rank p=0.0010). 4-year disease-free survival for patients with UICC stage I disease in the CME group was 100% compared with 89.8% (83.1-96.6) in the non-CME group (log-rank p=0.046). For patients with UICC stage II disease, 4-year disease-free survival was 91.9% (95% CI 87.2-96.6) in the CME group compared with 77.9% (71.6-84.1) in the non-CME group (log-rank p=0.0033), and for patients with UICC stage III disease, it was 73.5% (63.6-83.5) in the CME group compared with 67.5% (61.8-73.2) in the non-CME group (log-rank p=0.13). Multivariable Cox regression showed that CME surgery was a significant, independent predictive factor for higher disease-free survival for all patients (hazard ratio 0.59, 95% CI 0.42-0.83), and also for patients with UICC stage II (0.44, 0.23-0.86) and stage III disease (0.64, 0.42-1.00). After propensity score matching, disease-free survival was significantly higher after CME, irrespective of UICC stage, with 4-year disease-free survival of 85.8% (95% CI 81.4-90.1) after CME and 73.4% (66.2-80.6) after non-CME (log-rank p=0·0014).INTERPRETATION: Our data indicate that CME surgery is associated with better disease-free survival than is conventional colon cancer resection for patients with stage I-III colon adenocarcinoma. Implementation of CME surgery might improve outcomes for patients with colon cancer.FUNDING: Tvergaards Fund and Edgar and Hustru Gilberte Schnohrs Fund.

KW - Adenocarcinoma

KW - Adenocarcinoma, Mucinous

KW - Aged

KW - Carcinoma, Medullary

KW - Carcinoma, Signet Ring Cell

KW - Colonic Neoplasms

KW - Denmark

KW - Disease-Free Survival

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lymphatic Metastasis

KW - Male

KW - Mesocolon

KW - Middle Aged

KW - Neoplasm Staging

KW - Prognosis

KW - Retrospective Studies

KW - Survival Rate

KW - Comparative Study

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/S1470-2045(14)71168-4

DO - 10.1016/S1470-2045(14)71168-4

M3 - Journal article

C2 - 25555421

SN - 1470-2045

VL - 16

SP - 161

EP - 168

JO - The Lancet Oncology

JF - The Lancet Oncology

IS - 2

ER -

Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this