The mesocolon: a prospective observational study

Culligan, Kevin; Coffey, J. Calvin; Kiran, Ravi P.; Kalady, Matthew F.; Lavery, Ian C.; Remzi, Feza H.

doi:10.1111/j.1463-1318.2012.02935.x

Cited by 106 publications

(71 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The caecum, ascending colon and hepatic flexure including the corresponding mesocolon can easily be separated from the parietal fascia, the duodenum and the pancreatic head within an embryological interface [12]. It is possible to gently open this interface that reveals thin areolar tissue without breaching the fascial layers on either side [13].…”

Section: Discussionmentioning

confidence: 99%

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

Stelzner

Hohenberger

Weber

et al. 2015

Int J Colorectal Dis

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

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

Stelzner

Hohenberger

Weber

et al. 2015

Int J Colorectal Dis

View full text Add to dashboard Cite

“…In the 5-mm embryo, the colon develops within a dorsal mesentery all along its course; the 270° counterclockwise rotation of the primitive mid-gut along the axis of the SMA determines the folding of the dorsal mesentery, giving rise to the future mesocolon (14-17): Sir Frederick Treves (18) affirmed that right (and left) mesocolon "fuses" with the primitive posterior parietal peritoneum, obliterating the space between these embryonic structures; yet, Goligher (19) demonstrated the feasibility of stripping back the colon and its meso toward the midline (its primitive embryological The concept of CME is based on sharp division of the primitive mesocolon, deriving from splanchnopleuric layer of lateral mesoderm, and the primitive parietal peritoneum, derived from somatopleural layer of mesoderm, developing the avascular plane between the mesofascial and the retrofascial interface (22), along the plane of Toldt (the same concept of the Holy plane introduced by Heald et al (3) for TME): this latter is not thus simply confined to the lateral peritoneal attachment (white line of Toldt), but occurs as a result of condensation of mesofascial interface fibers, all along the mesocolon course, up to its mesenteric insertion.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Complete Mesocolic Excision with Central Vascular Ligation in right colon cancer: long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery

Siani

Pulica

2014

Scand J Surg

View full text Add to dashboard Cite

Aim: to analyze our experience in translating the concept of total mesorectal excision to "no-touch" complete removal of an intact mesocolonic envelope (complete mesocolic excision), along with central vascular ligation and apical node dissection, in the surgical treatment of right-sided colonic cancers, comparing "mesocolic" to less radical "nonmesocolic" planes of surgery in respect to quality of the surgical specimen and long-term oncologic outcome.Method: a total of 115 patients with right-sided colonic cancers were retrospectively enrolled from 2008 to 2013 and operated on following the intent of minimally invasive complete mesocolic excision with central vascular ligation.Results: morbidity and mortality were 22.6% and 1.7%, respectively. mesocolic, intramesocolic, and muscularis propria planes of resection were achieved in 65.2%, 21.7%, and 13% of cases, respectively, with significant impact for mesenteric plane of surgery on r0 resection rate (97.3%), circumferential resection margin <1 mm (2.6%), and consequent survival advantage (82.6% at 5 years) when compared to muscularis propria plane of surgery, with r0 resection rate and overall survival falling to 72% and 60%, respectively, and with circumferential resection margin <1 mm raising to 33.3%, all being statistically significant. stratifying patients for stage of disease, laparoscopic complete mesocolic excision with central vascular ligation significantly impacted survival in patients with stage ii, iiia/B, and in a subgroup of iiic patients with negative apical nodes.Conclusion: in our experience, minimally invasive complete mesocolic excision with central vascular ligation allows for both safety and higher quality of surgical specimens

show abstract

“…1 In the adult human, the transverse and lateral sigmoid portions of the mesocolon are mobile whereas the ascending, descending, and medial sigmoid portions are nonmobile and attached to underlying retroperitoneum. [2][3][4] Classic anatomic teaching maintains that the ascending and descending mesocolon "disappear" during embryogenesis. 5,6 In keeping with this, the identification of a right or left mesocolon in the adult is frequently depicted as anomalous rather than accepted as an anatomic norm.…”

mentioning

confidence: 99%

The Mesocolon

et al. 2014

View full text Add to dashboard Cite

Background: Colonic mobilization requires separation of mesocolon from underlying fascia. Despite the surgical importance of planes formed by these structures, no study has formally characterized their microscopic features. The aim of this study was to determine the histological and electron microscopic appearance of mesocolon, fascia, and retroperitoneum, prior to and after colonic mobilization. Methods: In 24 cadavers, samples were taken from right, transverse, descending, and sigmoid mesocolon. In 12 cadavers, specimens were stained with hematoxylin and eosin (3 sections) or Masson trichrome (3 sections). In the second 12 cadavers, lymphatic channels were identified by staining immunohistochemically for podoplanin. The ascending mesocolon was assessed with scanning electron microscopy. The above process was first conducted with the mesocolon in situ. The mesocolon was then surgically mobilized, and the process was repeated on remaining structures. Results: The microscopic structure of mesocolon and associated fascia was consistent from ileocecal to mesorectal level. A surface mesothelium and underlying connective tissue were evident throughout. Fibrous septae separated adipocyte lobules. Where apposed to retroperitoneum, 2 mesothelial layers separated mesocolon and underlying retroperitoneum. A connective tissue layer occurred between these (ie, Toldt's fascia). Lymphatic channels were evident both in mesocolic connective tissue and Toldt's fascia. After surgical separation of mesocolon and fascia both remained contiguous, the fascia remained in situ and the retroperitoneum undisturbed.Conclusions: The findings demonstrate that the contiguous mesocolon and retroperitoneum are separated by mesothelial and connective tissue layers. These properties generate the surgical planes (ie, meso-and retrofascial planes) exploited in colonic and mesocolic mobilization.

show abstract

The mesocolon: a prospective observational study

Cited by 106 publications

References 20 publications

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

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

Laparoscopic Complete Mesocolic Excision with Central Vascular Ligation in right colon cancer: long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery

The Mesocolon

Contact Info

Product

Resources

About