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International Journal of Colorectal Disease

, Volume 29, Issue 4, pp 419–428 | Cite as

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

Proceedings of a consensus conference
  • K. Søndenaa
  • P. Quirke
  • W. Hohenberger
  • K. Sugihara
  • H. Kobayashi
  • H. Kessler
  • G. Brown
  • V. Tudyka
  • A. D’Hoore
  • R. H. Kennedy
  • N. P. West
  • S. H. Kim
  • R. Heald
  • K. E. Storli
  • A. Nesbakken
  • B. Moran
Review

Abstract

Background

It has been evident for a while that the result after resection for colon cancer may not have been optimal. Several years ago, this was showed by some leading surgeons in the USA but a concept of improving results was not consistently pursued. Later, surgeons in Europe and Japan have increasingly adopted the more radical principle of complete mesocolic excision (CME) as the optimal approach for colon cancer. The concept of CME is a similar philosophy to that of total mesorectal excision for rectal cancer and precise terminology and optimal surgery are key factors.

Method

There are three essential components to CME. The main component involves a dissection between the mesenteric plane and the parietal fascia and removal of the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains all lymph nodes draining the tumour area (Hohenberger et al., Colorectal Disease 11:354–365, 2009; West et al., J Clin Oncol 28:272–278, 2009). The second component is a central vascular tie to completely remove all lymph nodes in the central (vertical) direction. The third component is resection of an adequate length of bowel to remove involved pericolic lymph nodes in the longitudinal direction.

Result

The oncological rationale for CME and various technical aspects of the surgical management will be explored.

Conclusion

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.

Keywords

Colon cancer Surgery Laparoscopy Complete mesocolic excision Lymph node metastasis 

Notes

Acknowledgments

Albert Wolthuis, Ole Sjo, Chris Hunter, and Dejan Ignjatovic contributed to the conference in various ways and we are grateful for their contributions. The conference was sponsored by Covidien, K Storz AS, Johnson&Johnson, Olympus, and Endotech. Other contributors were Haraldsplass Deaconess Hospital and The Norwegian Medical Association. PQ and NPW are supported by Yorkshire Cancer Research, NPW by the Pathological Society of Great Britain & Ireland, and PQ by the CRUK and ECMC centres.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • K. Søndenaa
    • 1
    • 2
  • P. Quirke
    • 3
  • W. Hohenberger
    • 4
  • K. Sugihara
    • 5
  • H. Kobayashi
    • 5
  • H. Kessler
    • 6
  • G. Brown
    • 7
  • V. Tudyka
    • 7
  • A. D’Hoore
    • 8
  • R. H. Kennedy
    • 9
  • N. P. West
    • 3
  • S. H. Kim
    • 10
  • R. Heald
    • 11
  • K. E. Storli
    • 1
  • A. Nesbakken
    • 12
  • B. Moran
    • 11
  1. 1.Department of SurgeryHaraldsplass Deaconess HospitalBergenNorway
  2. 2.Department of Clinical MedicineUniversity of BergenBergenNorway
  3. 3.Pathology, Anatomy and Tumour Biology, Leeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
  4. 4.Department of SurgeryUniversity of ErlangenErlangenGermany
  5. 5.Department of Surgical OncologyTokyo Medical and Dental UniversityTokyoJapan
  6. 6.Digestive DiseasesCleveland ClinicClevelandUSA
  7. 7.Department of RadiologyRoyal Marsden HospitalLondonUK
  8. 8.Department of SurgeryUniversity of LeuvenLeuvenBelgium
  9. 9.Department of SurgerySt. Mark’s HospitalHarrowUK
  10. 10.Department of SurgeryKorea University, Anam HospitalSeoulSouth Korea
  11. 11.The Pelican Cancer FoundationBasingstokeUK
  12. 12.Department of SurgeryOslo University HospitalOsloNorway

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