Since the first application of laparoscopic surgery in 1991 4, laparoscopic technique has been introduced to many surgical fields such as the treatment of crc with the advanced laparoscopic. Abstractthe definition of complete mesocolic excision cme for colon carcinomas revolutionized the way of colon surgery. Complete mesocolic excision, a new way of performing surgery in patients with stage iiii colon cancer, is shown to improve disease free survival. Safety, quality and effect of complete mesocolic excision vs non complete mesocolic excision in patients with colon cancer. Culligan first formally characterized the mesocolonic anatomy, explaining the reason why cme. In cme, the fascial space of the posterior lobe of the mesocolon is completely dissected to separate the fusion fascia from the visceral fascia and the parietal fascia up to the radix of the mesocolon 68. In the past, rectal cancer patients tended to have a poorer disease free and overall survival than compared to those with colon cancer 15. Initial retrospective case series and comparative studies have shown promising oncological outcomes.
Pdf completed mesocolic excision for right colon cancer. In this article we discussed the difference between the singleport and conventional laparoscopic cme surgery for right colon cancer and. Laparoscopic complete mesocolic excision for cancer of the. Complete mesocolic excision for colon cancer has gained increasing popularity over recent years following publication of the erlangen experience in 2009.
Society of american gastrointestinal and endoscopic surgeons sages 391 views 7. Complete mesocolic excision cme attempts to adopt the same principles as that of tme and apply it to colon cancer surgery. Jul 28, 2015 in this video dr nick west from the leeds institute of cancer and pathology explains in detail all the relevant principles of and background to complete mesocolic excision and its usefulness with. Optimal colonic cancer surgery the concept of complete. The aim of the study was to evaluate the oncological outcomes of complete mesocolic excision cme in colon cancer patients. Complete mesocolic excision is believed to play an important role in the treatment for colon cancer. Shin and colleagues report in the current issue on a series of 168 patients with stages ii and iii colon carcinoma treated with laparoscopic cme, who achieved a remarkable overall survival of 89. Jul 04, 2014 complete mesocolic excision complete mesocolic excision stocchi, l.
Dec 15, 2015 complete mesocolic excision cme for the treatment of colon cancer was first introduced in the west in 2008. Application of this tcme reduces local fiveyear recurrence rates in colon cancer from 6. May 17, 2017 laparoscopic subtotal colectomy with complete mesocolic excision for colonic adenocarcinoma duration. Complete mesocolic excision and central vascular ligation for. Minimally invasive complete mesocolic excision for right. The incomplete story of complete mesocolic excision the.
Complete mesocolic excision cme for the treatment of colon cancer. The significant results from the erlangen team showed a reduction in the 5year local recurrence rates from 6. Abdelkhalek m, setit a, bianco f, belli a, denewer a, youssef tf, et al. Abstract complete mesocolic excision cme with central vascular. Laparoscopic complete mesocolic excision for central lymph. Cme is considered a standard procedure for colon cancer patients. Based on these experiences, the concept of embryonic plane dissection was translated to surgery of colon cancer as complete mesocolic excision cme and central vascular ligation cvl. Jan 15, 2017 universitatsklinikum erlangen standardised surgery for colonic cancer. Oct 30, 2018 total mesorectal excision tme is a wellestablished technique for the management of rectal cancer which has significantly reduced local recurrence rate. Complete mesocolic excision with central vascular ligation for the. Society for translational medicine expert consensus statement total mesorectal excision tme, a revolutionary change and a milestone in the history of surgical treatment for rectal cancer, has been widely recognized as the gold standard and is now a routine procedure.
Disease free and overall survival were comparable, and in some centres, even surpassing. This technique conquered the world starting from erlangen. The concept of complete mesocolic excision in 2009, translating the concept of tme, came the first report and description of the complete mesocolic excision cme with central vascular ligation cvl from the erlanger group of hohenberger with impressive oncological outcomes. Total mesorectal excision tme improves local recurrence rates and so it is accepted as the gold standard surgical method for locally advanced rectal cancer surgery. While evidence has shown that laparoscopic surgery is not a technique barrier for cme, the feasibility of singleport laparoscopy is still controversial. The clinical data of 172 patients who underwent laparoscopic cme for right colon cancer and were admitted to the first affiliated hospital of nanjing medical university from january 2010 to april 2015 were retrospectively. Complete mesocolic excision society of american gastrointestinal and endoscopic surgeons sages. The last 2 issues of techniques in coloproctology present 2 examples of the technique referred to as complete mesocolic excision cme. Implementing complete mesocolic excision for colon cancer. Nevertheless, currently new developments especially in minimally invasive surgery challenge cme to become settled as a standard of care. Complete mesocolic excision for right colon cancer. Complete mesocolic excision cme for the treatment of colon cancer was first introduced in the west in 2008.
What is a complete mesocolicexcision cme for colon cancer. The main objective of this study is to evaluate the safety and effectiveness of complete mesocolic excision for colon cancer treatment. Despite that complete mesocolic excision cme has been conducted for many years, leading to a better outcome in colon cancer patients, there are limited studies on the structure of the mesocolon or related attachments, which is of great importance for surgeons to carry out surgery, until k. Roboticassisted complete mesocolic excision, central. Complete mesocolic excision cme attempts to adopt the same principles as that of tme and apply it to colon cancer sur. Laparoscopic complete mesocolic excision and central vascular ligation for rightsided colon cancer using the retroperitoneal approach.
Clinical outcome of laparoscopic complete mesocolic excision. Robotic right hemicolectomy with d3 lymphadenectomy and. To understand the evolution of cme, anatomical details. Minimally invasive complete mesocolic excision and central. Introduction the right colon cancers have been traditionally treated with a standard. Pdf complete mesocolic excision cme for the treatment of colon cancer was first introduced in the west. However, previous evidence regarding the effect of cme on prognosis has fundamental limitations that prevent it from being fully. Rj heald surgical technique rectal cancer the holy plane of rectal cancer sharp dissection between the visceral fascia mesorectum and parietal fascia waldeyer denonvilliers specimen with. The definition of complete mesocolic excision cme for colon carcinomas revolutionized the way of colon surgery. This relatively new concept of a complete mesocolic excision cme with central. The concept of complete mesocolic excision in 2009, translating the concept of tme, came the first report and description of the complete mesocolic excision cme with central vascular ligation cvl from the erlanger group of hohenberger with impressive oncological outcomes and an overall 5 year survival reaching up to 70% for stage iii colon. Total or complete mesocolic excision cme, use planar surgery and extensive mesenterectomy high tie to minimise breach of the mesentery and maximise lymph nodes yield. Complete mesocolic excision with central vascular ligation in comparison with conventional surgery for patients with colon cancer the experiences at two centers.
Standardized surgery for colonic cancer complete mesocolic. Efficacy and safety of complete mesocolic excision in patien. Postoperative morbidity of complete mesocolic excision and. Classic colon cancer surgery refers to a wide resection of the tumorbearing segment and the lymphatics draining along the named artery. Laparoscopic cme combines the above advantages theoretically, while it is still in the early stages of application for the higher quality requirements and longer learning curve of cme. This is how the concept of complete mesocolic excision appeared. Complete mesocolic excision cme was first proposed by the german scholar hohenberger in 2009, 1 and since has been widely used clinically as an open technique. Moreover, cme surgery is associated with better diseasefree survival than is a conventional colon cancer resection for patients with a stage iiii. Complete mesocolic excision cme is considered to be the standard crc surgeries due to it can reduce local recurrence and improve longterm survival. What is a complete mesocolicexcision for colon cancer. Laparoscopic complete mesocolic excision and central vascula. Diseasefree survival after complete mesocolic excision com pared with conventional. Comparison of shortterm outcomes between laparoscopic. Totally robotic modified complete mesocolic excision and central vascular ligation for rightsided colon cancer.
Complete mesocolic excision with central supplying vessel. Forest plot displaying the results of the meta analysis on disease free survival. Pdf complete mesocolic excision cme for the treatment of colon cancer was first introduced in the west in 2008. Totally robotic complete mesocolic excision for rightsided colon cancer. Sep 18, 2017 this study aimed to investigate the clinical outcome of complete mesocolic excision cme with a caudaltocranial medial approach in the treatment of right colon cancer. Several studies have suggested an increased lymph node yield, reduced locoregional recurrence and increased disease. However, since the advent of total mesorectal excision tme by heald and ryall, oncological outcomes of rectal cancer surgery remarkably improved 6,7. Disease free and overall survival were comparable, and in some centres, even. The authors found compelling improvements in recurrence and survival with complete mesocolic excision.
Total mesorectal excision revolutionised rectal cancer. Complete mesocolic excision, techniques in coloproctology. Complete mesocolic excision cme principle based upon tme total mesorectal excision principle prof. By removing the mesorectum completely, local recurrence was substantially reduced. A unique compilation of multidisciplinary video lectures on surgery, radiology and pathology.
Complete mesocolic excision for right colon cancer zenger. Complete mesocolic excision has the potential to reduce the risk of recurrence and improve longterm outcome after resection for all uicc stages iiii of rightsided colon adenocarcinomas. Sur vival introduction colorectal cancer is a major health problem, being the third. In this video dr nick west from the leeds institute of cancer and pathology explains in detail all the relevant principles of and background to complete mesocolic excision. The incomplete story of complete mesocolic excision the lancet. There is evidence that complete mesocolic excision cme of lymph nodes is associated with superior oncological outcomes including longer disease free survival in patients with colorectal cancer than standard lymph node dissection and there is increasing evidence to suggest that the robotic approach may be superior to laparoscopic or open cme. Complete mesocolic excision with central vascular ligation. The first aim of this procedure is to remove the afflicted colon and its accessory. Complete mesocolic excision cme and central ligation technical notes and outcome colorectal dis 2009, 11. The first aim of this procedure is to remove the afflicted colon and its accessory lymphovascular supply by resecting the colon and mesocolon in an intact envelope of visceral peritoneum, which holds potentially involved lymph nodes. Survival after complete mesocolic excision cme for right. In recent years, the concept of complete mesocolic excision cme with dissection adhering to embryological planes and central vascular ligation cvl has also been adopted to colonic resection 2,3,4,5,6.
Comparison of outcomes of complete mesocolic excision with. Complete mesocolic excision with central vascular ligation in. Proposed in 2008 by w hohenberger principles are identical to tme 1 dissection between the mesenteric plane and the parietal fascia and removal of the mesentery within a complete envelope of fascia and visceral peritoneum that contain all lymph nodes draining the tumor area. Survival after complete mesocolic excision cme for right sided coloncancer compared to standard surgery the open surgery journal, 20, 7. In the other important study showed that diseasefree survival rates were higher in the. Conclusion w e believe that robotic right hemicolectomy with d3 lymphadenectomy, with complete mesocolic excision, is a realistic and feasible operation for right colon cancers. The authors presented the 3year interim results of the efficacy study of complete mesocolic excision, which is a prospective, nonrandomized study with a planned duration of 5 years, started in 2012. Hohenberger9 coined the term complete mesocolic excision cme with central vascular ligation cvl for this technique. Complete mesocolic excision cme is a highquality colon radical surgery, which follows fine surgical dissection and precise surgical concept.
This study shows a causal treatment effect of central mesocolic lymph node excision on risk of recurrence after resection for rightsided colon adenocarcinoma. Total mesorectal excision tme has been the miracle surgical technique which has since allowed the outcomes of rectal cancer to surpass that of colon cancer. The concept of tme has been applied to colon cancer and complete mesocolic excision cme in conjuction with central vascular ligation cvl has been introduced as the surgical treatment for colon cancer. Minimally invasive complete mesocolic excision for right colon cancer.