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International Journal of Colorectal Disease
Erschienen in: International Journal of Colorectal Disease 4/2014

01.04.2014 | Review

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

verfasst von: 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

Erschienen in: International Journal of Colorectal Disease | Ausgabe 4/2014

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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.
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Metadaten
Titel
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
verfasst von
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
Publikationsdatum
01.04.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 4/2014
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-013-1818-2

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