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Complete Mesocolic Excision and Central Vascular Ligation: History and Outcome

  • Seok-Byung Lim
  • Jin Cheon KimEmail author
Chapter

Abstract

Surgical excision with the en-bloc removal of regional lymph nodes is currently the most promising treatment for colon cancer. Complete mesocolic excision (CME) with central vascular ligation (CVL) has recently been introduced in colon cancer surgery as a concept similar to total mesorectal excision (TME) for rectal cancer. This surgical technique involves oncologic resection with careful dissection of the mesocolon along the embryological tissue planes, which results in a colon and mesocolon specimen lined by intact fascial coverage of the tumor and containing all blood vessels, lymphatic vessels, lymph nodes, and surrounding soft tissue that may contain disseminated cancer cells. Subsequent studies have proved the feasibility and safety of the CME with CVL technique in open, laparoscopic, and even robotic surgery for colon cancer. Although the long-term survival benefit of the CME with CVL procedure has not been proven, it should be considered a standard surgical procedure in colon cancer surgery based on the anatomical and oncological backgrounds.

Keywords

Complete mesocolic excision (CME) Central vascular ligation (CVL) Outcome 

References

  1. 1.
    Ruo L, Guillem JG. Surgical management of primary colorectal cancer. Surg Oncol. 1998;7:153–63.CrossRefGoogle Scholar
  2. 2.
    Bokey EL, Chapuis PH, Dent OF, Mander BJ, Bissett IP, Newland RC. Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon Rectum. 2003;46:860–6.CrossRefGoogle Scholar
  3. 3.
    West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9:857–65.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    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. Color Dis. 2009;11:354–64.CrossRefGoogle Scholar
  5. 5.
    Culligan K, Remzi FH, Soop M, Coffey JC. Review of nomenclature in colonic surgery–proposal of a standardized nomenclature based on mesocolic anatomy. Surgeon. 2013;11:1–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Gouvas N, Agalianos C, Papaparaskeva K, Perrakis A, Hohenberger W, Xynos E. Surgery along the embryological planes for colon cancer: a systematic review of complete mesocolic excision. Int J Color Dis. 2016;31:1577–94.CrossRefGoogle Scholar
  7. 7.
    Morikawa E, Yasutomi M, Shindou K, Matsuda T, Mori N, Hida J, et al. Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing method. Dis Colon Rectum. 1994;37:219–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Toyota S, Ohta H, Anazawa S. Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum. 1995;38:705–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Cho MS, Baek SJ, Hur H, Soh Min B, Baik SH, Kyu Kim N. Modified complete mesocolic excision with central vascular ligation for the treatment of right-sided colon cancer: long-term outcomes and prognostic factors. Ann Surg. 2015;261:708–15.CrossRefPubMedGoogle Scholar
  10. 10.
    West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol. 2010;28:272–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Danish Colorectal Cancer Group, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol. 2015;16:161–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kontovounisios C, Kinross J, Tan E, Brown G, Rasheed S, Tekkis P. Complete mesocolic excision in colorectal cancer: a systematic review. Color Dis. 2015;17:7–16.CrossRefGoogle Scholar
  13. 13.
    Athanasiou CD, Markides GA, Kotb A, Jia X, Gonsalves S, Miskovic D. Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Color Dis. 2016;18:O224–35.CrossRefGoogle Scholar
  14. 14.
    Hogan AM, Winter DC. Complete mesocolic excision (CME): a “novel” concept? J Surg Oncol. 2009;100(3):182.CrossRefPubMedGoogle Scholar
  15. 15.
    Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2017;20(2):207–39.  https://doi.org/10.1007/s10147-017-1101-6.CrossRefGoogle Scholar
  16. 16.
    West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012;30:1763–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kobayashi H, West NP, Takahashi K, Perrakis A, Weber K, Hohenberger W, et al. Quality of surgery for stage III colon cancer: comparison between England, Germany, and Japan. Ann Surg Oncol. 2014;21:S398–404.CrossRefPubMedGoogle Scholar
  18. 18.
    Killeen S, Mannion M, Devaney A, Winter DC. Complete mesocolic resection and extended lymphadenectomy for colon cancer: a systematic review. Color Dis. 2014;16:577–94.CrossRefGoogle Scholar
  19. 19.
    Shin JW, Amar AH, Kim SH, Kwak JM, Baek SJ, Cho JS, et al. Complete mesocolic excision with D3 lymph node dissection in laparoscopic colectomy for stages II and III colon cancer: long-term oncologic outcomes in 168 patients. Tech Coloproctol. 2014;18:795–803.CrossRefPubMedGoogle Scholar
  20. 20.
    Feng B, Sun J, Ling TL, AG L, Wang ML, Chen XY, et al. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc. 2012;26:3669–75.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Willaert W, Ceelen W. Extent of surgery in cancer of the colon: is more better? World J Gastroenterol. 2015;21:132–8.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Neuenschwander AU, Vilandt J. Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Color Dis. 2011;13:1123–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulSouth Korea

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