Skip to main content

Advertisement

SpringerLink
Log in

Complete mesocolic excision and central vascular ligation for right colon cancer: an introduction for abdominal radiologists

  • Special Section: Rectal Cancer
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

To provide an overview of complete mesocolic excision, along with a review of the relevant vascular anatomy and locoregional staging concepts, for abdominal radiologists.

Results

Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer has emerged as a technique that has growing interest in surgical oncology. Specific anatomic considerations and patterns of nodal spread have thus gained clinical significance, and should be familiar to abdominal radiologists. This review article provides an overview of CME with CVL, and discusses some of the important anatomic considerations in patients with colon cancer that are relevant to radiologists.

Conclusion

Knowledge of CME with CVL and the relevant anatomic and staging considerations is important for abdominal radiologists, as this surgical technique becomes increasingly utilized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Illustrations by Christopher M. Brown

Fig. 2

Illustrations by Christopher M. Brown

Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982;69(10):613-6.

    Article  CAS  Google Scholar 

  2. Maurer CA, Renzulli P, Kull C, Kaser SA, Mazzucchelli L, Ulrich A, et al. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol. 2011;18(7):1899-906.

    Article  CAS  Google Scholar 

  3. Beets-Tan RGH, Lambregts DMJ, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, et al. Magnetic resonance imaging for clinical management of rectal cancer: Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. European radiology. 2018;28(4):1465-75.

    Article  Google Scholar 

  4. Gollub MJ, Arya S, Beets-Tan RG, dePrisco G, Gonen M, Jhaveri K, et al. Use of magnetic resonance imaging in rectal cancer patients: Society of Abdominal Radiology (SAR) rectal cancer disease-focused panel (DFP) recommendations 2017. Abdominal radiology (New York). 2018;43(11):2893-902.

    Article  Google Scholar 

  5. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis. 2009;11(4):354-64; discussion 64-5.

  6. Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol. 2015;16(2):161-8.

    Article  Google Scholar 

  7. Guerrieri M, Campagnacci R, De Sanctis A, Lezoche G, Massucco P, Summa M, et al. Laparoscopic versus open colectomy for TNM stage III colon cancer: results of a prospective multicenter study in Italy. Surg Today. 2012;42(11):1071-7.

    Article  Google Scholar 

  8. Negoi I, Beuran M, Hostiuc S, Negoi RI, Inoue Y. Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis. Scientific reports. 2018;8(1):4184.

    Article  Google Scholar 

  9. Shen J, Xie D, Tong Y, Gong J. The length and complexity of mesentery are related to the locoregional recurrence of the carcinoma in gut. Med Hypotheses. 2017;103:133-5.

    Article  Google Scholar 

  10. Kim NK, Kim YW, Han YD, Cho MS, Hur H, Min BS, et al. Complete mesocolic excision and central vascular ligation for colon cancer: Principle, anatomy, surgical technique, and outcomes. Surg Oncol. 2016;25(3):252-62.

    Article  Google Scholar 

  11. Amri R, Klos CL, Bordeianou L, Berger DL. The prognostic value of lymph node ratio in colon cancer is independent of resection length. Am J Surg. 2016;212(2):251-7.

    Article  Google Scholar 

  12. Deijen CL, Vasmel JE, de Lange-de Klerk ESM, Cuesta MA, Coene PLO, Lange JF, et al. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surg Endosc. 2017;31(6):2607-15.

    Article  Google Scholar 

  13. Hazebroek EJ, Color Study G. COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc. 2002;16(6):949-53.

    Article  Google Scholar 

  14. Gao Y, Lu Y. Variations of Gastrocolic Trunk of Henle and Its Significance in Gastrocolic Surgery. Gastroenterol Res Pract. 2018;2018:3573680.

    PubMed  PubMed Central  Google Scholar 

  15. Nerad E, Lahaye MJ, Maas M, Nelemans P, Bakers FC, Beets GL, et al. Diagnostic Accuracy of CT for Local Staging of Colon Cancer: A Systematic Review and Meta-Analysis. AJR American journal of roentgenology. 2016;207(5):984-95.

    Article  Google Scholar 

  16. Bertelsen CA, Kirkegaard-Klitbo A, Nielsen M, Leotta SM, Daisuke F, Gogenur I. Pattern of Colon Cancer Lymph Node Metastases in Patients Undergoing Central Mesocolic Lymph Node Excision: A Systematic Review. Diseases of the colon and rectum. 2016;59(12):1209-21.

    Article  Google Scholar 

  17. Perrakis A, Weber K, Merkel S, Matzel K, Agaimy A, Gebbert C, et al. Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. International journal of colorectal disease. 2014;29(10):1223-9.

  18. Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Jepsen LV, Kristensen B, et al. Lymph node metastases in the gastrocolic ligament in patients with colon cancer. Diseases of the colon and rectum. 2014;57(7):839-45.

    Article  Google Scholar 

  19. Benz SR, Tannapfel A, Tam Y, Stricker I. [Complete Mesocolic Excision for Right-Sided Colon Cancer - The Role of Central Lymph Nodes]. Zentralblatt fur Chirurgie. 2015;140(4):449-52.

    CAS  PubMed  Google Scholar 

  20. Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Prognostic Impact of Distribution of Lymph Node Metastases in Stage III Colon Cancer. World journal of surgery. 2015;39(12):3008-15.

    Article  Google Scholar 

  21. Graf O, Boland GW, Kaufman JA, Warshaw AL, Fernandez del Castillo C, Mueller PR. Anatomic variants of mesenteric veins: depiction with helical CT venography. AJR American journal of roentgenology. 1997;168(5):1209-13.

  22. Sakaguchi T, Suzuki S, Morita Y, Oishi K, Suzuki A, Fukumoto K, et al. Analysis of anatomic variants of mesenteric veins by 3-dimensional portography using multidetector-row computed tomography. Am J Surg. 2010;200(1):15-22.

    Article  Google Scholar 

  23. Ogino T, Takemasa I, Horitsugi G, Furuyashiki M, Ohta K, Uemura M, et al. Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer. Ann Surg Oncol. 2014;21 Suppl 3:S429-35.

    Article  Google Scholar 

  24. Miyazawa M, Kawai M, Hirono S, Okada K, Shimizu A, Kitahata Y, et al. Preoperative evaluation of the confluent drainage veins to the gastrocolic trunk of Henle: understanding the surgical vascular anatomy during pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci. 2015;22(5):386-91.

    Article  Google Scholar 

  25. Toyota S, Ohta H, Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Diseases of the colon and rectum. 1995;38(7):705-11.

    Article  CAS  Google Scholar 

  26. Marcello PW, Roberts PL, Rusin LC, Holubkov R, Schoetz DJ. Vascular pedicle ligation techniques during laparoscopic colectomy. A prospective randomized trial. Surg Endosc. 2006;20(2):263-9.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    David D. B. Bates & Viktoriya Paroder

  2. Department of Radiology, University of Florida, Jacksonville, FL, USA

    Chandana Lall

  3. Department of Radiology, Wake Forest University and Baptist Health, Winston-Salem, NC, USA

    Neeraj Lalwani

  4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Maria Widmar & Julio Garcia-Aguilar

Authors
  1. David D. B. Bates
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Viktoriya Paroder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chandana Lall
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neeraj Lalwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Widmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Julio Garcia-Aguilar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David D. B. Bates.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bates, D.D.B., Paroder, V., Lall, C. et al. Complete mesocolic excision and central vascular ligation for right colon cancer: an introduction for abdominal radiologists. Abdom Radiol 44, 3518–3526 (2019). https://doi.org/10.1007/s00261-019-02037-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-019-02037-9

Keywords

Search

Navigation