Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer

Sylla, Patricia

doi:10.1007/978-3-030-66049-9_37

Cited by 1 publication

(1 citation statement)

References 59 publications

(134 reference statements)

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“…For sigmoid or distal descending colon tumours, mobilization of the splenic flexure, descending and sigmoid colon is performed according to established principles for a conventional resection with D2 lymphadenectomy (medial to lateral or lateral to medial). For a CME with CVL/D3 dissection, 30 the IMA is dissected at its origin from the aorta and skeletonised of all fibrofatty lymphatic tissue, while preserving the superior hypogastric plexus. The IMA is divided at its origin, the IMV is divided at the lower border of the pancreas and the left mesocolon between the two ligated vessels is released from the retroperitoneum.…”

Section: Surgical Techniquementioning

confidence: 99%

Complete mesocolic excision for colon cancer: current status and controversies

Brown,

Ng,

Solomon

et al. 2023

ANZ Journal of Surgery

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According to Hohenberger's original description, complete mesocolic excision for colon cancer involves precise dissection of the avascular embryonic plane between the parietal retroperitoneum and visceral peritoneum of the mesocolon. This ensures mesocolic integrity, access to high ligation of the supplying vessels at their origin and an associated extended lymphadenectomy. Results from centres which have adopted this approach routinely have demonstrated that oncological outcomes can be improved by the rigorous implementation of established principles of cancer surgery. Meticulous anatomical dissection along embryonic planes is a well‐established principle of precision cancer surgery used routinely by the specialist colorectal surgeon. Therefore, the real question concerns the need for true central vascular ligation and associated extended (D3) lymphadenectomy or otherwise, particularly along the superior mesenteric vessels when performing a right colectomy. Whether this approach results in improved overall or disease‐free survival remains unclear and its role remains controversial particularly given the potential for significant morbidity associated with a more extensive central vascular dissection. Current literature is limited by considerable bias, as well as inconsistent and variable terminology, and the results of established randomized trials are awaited. As a result of the current state of equipoise, various national guidelines have disparate recommendations as to when complete mesocolic excision should be performed if at all. This article aims to review the rationale for and technical aspects of complete mesocolic excision, summarize available short and long term outcome data and address current controversies.

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Section: Surgical Techniquementioning

confidence: 99%