22. TME PME – TME – Extend of Resection TU 5 cm PME Peritoneal Fold Ventral Prospect Dorsal Prospect Distal Resection Margin Distal Resection Margin with Contour ® -Stapler TU
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25. Outcome of Colon versus Rectal Cancer (5 yr relative survival) Data from ISD % courtesy Prof. R J C Steele / Dundee
26. Editioral Colonic surgery for cancer: a new paradigm While these advances were being made in rectal cancer ( - Bill Heald `s TME; - Phil Quirke `s circumferential margin) surgery for colonic cancer has been left untouched . Najib Haboubi, Colorectal Disease 2003, 11; 333-334, 2009
29. Anatomy of the Colon Mesocolon Lymphatic drainage pancreatic LN (head) superior mesenteric LN inferior pancreatic LN pyloric LN
30. Surgery for Colon Cancer Complete Mesocolic Excision (CME) Preservation of the mesocolic plane by sharp dissection off the parietal plane (turning embryology back) Regional and central lymphnode dissection with high tie of suppling vessels
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36. Methods – tissue morphometry D A = Distance from tumour to high tie B = Distance from nearest bowel wall to high tie C = Length of large intestine D = Cross sectional area of mesentery A B C D
37. 2 % 36 % 11 % Involved LN (%) Carcinoma of the transverse Colon (right flexure) Toyota et al. Dis Col Rect 1995; 38:705-711
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39. Colon Cancer Lymphnode Involvement N1 T 52 % N1 O/A 30 % N2 16 % N3 2 % 10 cm 5 cm 5 cm 10 cm Oral Anal N2 O N2 O N1 O N1 T N N2 A N2 A N2 N2 N3 K.Y. Tan et al 2010; n=281 node positive resection
40. number of OS DFS l.n. (n=1857) (n=1857) 0-10 (n=1020) 67% 65% 11-40 (n=807) 74% 70% >40 (n=30) 93% 90% Colon Cancer Extend of Lymphode Dissection Survival – pN1 5 years survival, number of l.n. examined Le Voyer et al, JCO 2003; 21: 2912