Tumor-Specific versus Complete Mesocolic Excision for Right-Sided Colon Cancer: A Multicenter Retrospective Study

초록

Objective: This study aimed to evaluate whether tumor-specific mesocolic excision (TSMCE) is a suitable alternative to complete mesocolic excision (CME) for right-sided colon cancer, to refine lymphadenectomy indications, and to improve oncologic and functional outcomes. Materials and Methods: In this multicenter retrospective study, patients who underwent curative right hemicolectomy with lymph node dissection for right-sided colon cancer were analyzed. Patients received either CME (including central vascular ligation and D3 dissection) or TSMCE. Clinical characteristics, lymph node yield, recurrence-free survival (RFS), and overall survival (OS) were compared. Propensity score matching (PSM) was performed (n = 498 per group), and Cox regression analysis was used to identify prognostic factors. Results: Patients in the CME group were older, more often male, and more frequently treated robotically. CME yielded more harvested (33.1 vs. 27.5) and metastatic (1.2 vs. 0.8) lymph nodes. RFS did not differ significantly between groups across all stages. OS was significantly better in Stage II (HR 0.64, 95% CI: 0.42–0.97) and N0 (HR 0.69, 95% CI: 0.48–0.98) patients undergoing CME. After PSM, the dissection method was not independently associated with RFS or OS. Older age, preoperative obstruction, higher nodal stage, lymphovascular, and perineural invasion were adverse factors, while adjuvant chemotherapy improved OS. Conclusion: Following adjustment for baseline characteristics, TSMCE and CME showed comparable oncologic outcomes. Routine use of extensive CME may not be necessary for all patients; however, certain subgroups appear to benefit, warranting further investigation.