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Complete mesocolic excision is defined as a surgical technique that comprises sharp dissection of the mesocolon’s visceral plane from the retroperitoneal plane without breaching of the visceral layer, which could lead to tumor cell spread within the peritoneal cavity. Hohenberger et al. [1] from Erlangen University first described complete mesocolic excision (CME) in conjunction with central vascular ligation (CVL) and demonstrated a correlation between anatomic and mesentery-based resection of right-sided colon cancer. Since CME became standard of care, 5-year local recurrence rates at Erlangen University Hospital decreased from 6.5 to 3.6% and 5-year cancer-related survival improved from 82.1 to 89.1% [1].
Several studies have demonstrated superior long-term oncological outcomes for CME [1,2,3]. Due to still unsatisfying long-term results of colon cancer surgery in many institutions, standardization of quality-based surgery worldwide is needed. Training programs play an essential role in improving outcomes for colon and rectal cancer [4, 5].
This video shows a systematic approach to laparoscopic extended right hemicolectomy with CME in a cadaveric model, which includes preservation of the mesocolic planes, medial to lateral colon mobilization, high vascular tie and central lymph node dissection and suggests a standard approach to this technique to be used in training programs.
References
Hohenberger W, Weber K, Matzel K et al (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Color Dis 11:354–364. https://doi.org/10.1111/j.1463-1318.2008.01735.x
Bertelsen CA, Neuenschwander AU, Jansen JE et al (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16:161–168. https://doi.org/10.1016/S1470-2045(14)71168-4
Kotake K, Mizuguchi T, Moritani K et al (2014) Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. Int J Colorectal Dis 29:847–852. https://doi.org/10.1007/s00384-014-1885-z
West NP, Hohenberger W, Weber K et al (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278. https://doi.org/10.1200/JCO.2009.24.1448
Bertelsen CA, Bols B, Ingeholm P et al (2011) Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Color Dis 13:1123–1129. https://doi.org/10.1111/j.1463-1318.2010.02474.x
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Kessler, H., Gouvea Monteiro de Camargo, M., Delaney, C.P. et al. Laparoscopic right hemicolectomy with complete mesocolic excision: a cadaver model. Tech Coloproctol 24, 259 (2020). https://doi.org/10.1007/s10151-019-02135-2
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DOI: https://doi.org/10.1007/s10151-019-02135-2