title: Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon.
abstract: OBJECTIVE
  The plane of surgery in colonic cancer has been linked to patient outcome although the optimal extent of mesenteric resection is still unclear. Surgeons in Erlangen, Germany, routinely perform complete mesocolic excision (CME) with central vascular ligation (CVL) and report 5-year survivals of higher than 89%. We aimed to further investigate the importance of CME and CVL surgery for colonic cancer by comparison with a series of standard specimens.
  
  
  METHODS
  The fresh photographs of 49 CME and CVL specimens from Erlangen and 40 standard specimens from Leeds, United Kingdom, for primary colonic adenocarcinoma were collected. Precise tissue morphometry and grading of the plane of surgery were performed before comparison to histopathologic variables.
  
  
  RESULTS
  CME and CVL surgery removed more tissue compared with standard surgery in terms of the distance between the tumor and the high vascular tie (median, 131 v 90 mm; P < .0001), the length of large bowel (median, 314 v 206 mm; P < .0001), and ileum removed (median, 83 v 63 mm; P = .003), and the area of mesentery (19,657 v 11,829 mm(2); P < .0001). In addition, CME and CVL surgery was associated with more mesocolic plane resections (92% v 40%; P < .0001) and a greater lymph node yield (median, 30 v 18; P < .0001).
  
  
  CONCLUSIONS
  Surgeons in Erlangen routinely practicing CME and CVL surgery remove more mesocolon and are more likely to resect in the mesocolic plane when compared with standard excisions. This, along with the associated greater lymph node yield, may partially explain the high 5-year survival rates reported in Erlangen.
authors: Pathology & Tumour Biology, Leeds Institute of Molecular Medicine, Level 4, Wellcome Trust Brenner Building, St James's University Hospital, Beckett St, Leeds, LS9 7TF, United Kingdom. n.p.west@leeds.ac.uk
authors: Nicholas P
authors: NP
authors: West
authors: Werner
authors: W
authors: Hohenberger
authors: Klaus
authors: K
authors: Weber
authors: Aristoteles
authors: A
authors: Perrakis
authors: Paul J
authors: PJ
authors: Finan
authors: Philip
authors: P
authors: Quirke
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000601:surgery*; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008646:Mesocolon / Q000601:surgery