LAUSR

To the Editor: We have read the interesting article by Gao et al presenting the results of a prospective nonrandomized, double-blind, controlled trial involving patients with colon cancer, who underwent surgery at the Peking University People’s Hospital in Beijing, China. The study aimed to evaluate the oncological outcomes of complete mesocolic excision in colon cancer patients. The authors concluded that compared with noncomplete mesocolic excision, complete mesocolic excision improves the 3-year local recurrence-free survival without increasing the surgical risks. We generally agree with the authors’ assertion that complete mesocolic excision, which is a well standardized surgery for colon cancer, also including central vascular ligation for maximizing lymph nodes harvesting, is associated with reduced local recurrence rates and better survival, in line with the current literature. However, the authors have listed 3 limitations of their study. We underline additional limitations that could question the authors’ conclusions. First, the sample size was calculated assuming that 9.0% of patients in the noncomplete mesocolic excision group would develop local recurrence, compared with 1.0% in the complete mesocolic excision group. However, using the same Japanese Society for Cancer of the Colon and Rectum classification of lymph node stations, other authors demonstrated a local recurrence rate of 1.87% for D2 lymphadenectomy, which corresponds to incomplete mesocolic excision, and 1.33% for D3 lymphadenectomy, which corresponds to complete mesocolic excision. Considering these values, the authors might have overestimated the impact of