The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery

Abstract

The consensus conference agreed that there are sound oncological hypotheses for a more radical approach than has been common up to now. However, this may not necessarily apply in early stages of the tumour stage. Laparoscopic resection appears to be equally well suited for resection as open surgery.

Laparoscopic Complete Mesocolic Excision versus Open Complete Mesocolic Excision for Transverse Colon Cancer: Long-Term Survival Results of a Prospective Single Centre Non-Randomized Study

“…The lymph nodes follow the lymph node vessels and are excised. This technique has been described in detail in several publications [4]. …”

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

“…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 choice of optimal lymph node dissection extent in surgical treatment for colon cancer: protocol the clinical trial

“…Как правило, техника СМЕ сочета-ется с высокой перевязкой сосудов (central vascular ligation, CVL). CVL не эквивалентна D3: питающий сосуд может быть лигирован как у основания, так и на расстоянии до 1 см от места отхождения [5].…”

“…При этом расширение объема вмешательства приводит к большему числу послеопе-рационных осложнений и функциональных наруше-ний, чем при стандартных резекциях [17]. Так, пере-вязка подвздошно-ободочной артерии вблизи верхней брыжеечной артерии может приводить к тяжелой диа-рее, парааортальная диссекция и лигирование нижней брыжеечной артерии у аорты -к повреждению гипо-гастрального сплетения, нарушению сексуальной функции и урологическим проблемам [5].…”