Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome

Abstract

The technique of CME in colon cancer surgery aims at a specimen with intact layers and a maximum of lymphnode harvest. This is translated into lower local recurrence rates and better overall survival.

Anatomy of the transverse colon revisited with respect to complete mesocolic excision and possible pathways of aberrant lymphatic tumor spread

“…It is reasonable to presume that an intact covering on the mesocolon, the mesocolic fascia, serves as a tumorarresting barrier in the same way as it was demonstrated for the mesorectal fascia [3,5]. It is one of the cornerstones of CME to respect the integrity of this embryological envelope [1,7].…”

“…Complete mesocolic excision (CME) describes the mobilisation and separation of the colon together with the entire regional mesocolon and supplying vessels as a contiguous and coherent embryologically defined compartment from the surrounding tissues in combination with a central vascular tie [1,2]. It represents the consequent extension of the philosophy of total mesorectal excision (TME) and of cancer-arresting capabilities of both the mesorectal and mesocolic fascia respectively to the entire large bowel [3][4][5].…”

The clinical significance of lymph node size in colon cancer

“…An insufficient surgical technique can lead to an incomplete lymph node resection. The clinical significance of an optimal surgical technique has been shown by Hohenberger et al 35 Unquestionably, the pathologist significantly influences the number of lymph nodes that are harvested, as long as he/she is provided with an adequate specimen. Diligence and the use of advanced methods like fat clearance or methylene blue technique have an important role.…”

S3-Leitlinie – Kolorektales Karzinom

“…Sie führt zu qualitativ höherwertigen Präparaten [708,709]. Höhere Komplikationsraten scheinen mit Erhöhung der Radikalität nicht verbunden zu sein [710].…”

“…Höhere Komplikationsraten scheinen mit Erhöhung der Radikalität nicht verbunden zu sein [710]. Die bisherigen Daten deuten auf eine Verbesserung der Überlebensraten bei konsequenter Durchführung der CME hin [708].…”