Five-year recurrence and postoperative complications after laparoscopic complete Mesocolic excision: A population-based, multicentred study.

[BACKGROUND] The oncological benefits of Laparoscopic Complete Mesocolic Excision (LCME) over conventional surgery are often challenged by single-centre designs, small cohorts or short and incomplete follow-up. This study aimed to examine the difference in recurrence risk 5 years after surgery and 30-day postoperative complications before and after a population-based, multicentre LCME implementation.

[METHOD] LCME was implemented in the Central Denmark Region, Denmark following a training programme in 2017 for all colon cancer surgeons. Colon cancer patients from before (2015-2016, PRE-group) and after the implementation (2018-2019, POST-group) were identified through the Danish Colorectal Cancer Group Database. Recurrence 5 years after surgery was ascertained through national registers using a validated algorithm. The Aalen-Johansen estimator for competing risk was used to calculate cumulative incidence of recurrence.

[RESULTS] A total of 1919 patients (PRE, n = 1024; POST, n = 895) underwent curative-intended surgery in the study period. The 5-year cumulative incidence of recurrence was 16.1% (95% CI: 13.8, 18.4) in the PRE group and 12.5% (95% CI: 10.2, 14.9) in the POST group, with a significant absolute risk difference of 3.6% (95% CI: 0.3, 6.9). Furthermore, a significantly lower hazard rate of recurrence was observed in stage II patients after the LCME implementation, with a hazard rate ratio of 0.42 (95% Cl: 0.24, 0.72). Risk of severe postoperative complications was also significantly lower in the POST, compared to the PRE group.

[CONCLUSION] LCME implementation was associated with a significantly lower risk of recurrence and lower rate of severe postoperative complications. This study indicates that multicentre LCME implementation may improve clinical outcomes without compromising patient safety.