title: Complete mesocolic excision in colorectal cancer: a systematic review.
abstract: OBJECTIVE
  Several studies have suggested an increased lymph node yield, reduced locoregional recurrence and increased disease-free survival after complete mesocolic excision (CME) for colorectal cancer. This review was undertaken to assess the use of CME for colon cancer by evaluating the technique and its clinical outcome.
  
  
  METHODS
  A literature search of publications was performed using PubMed and Medline. Only studies published in English were included. Studies assessed for quality and data were extracted by two independent reviewers. End-points included number of lymph nodes per patient, quality of the plane of mesocolic excision, postoperative mortality and morbidity, 5-year locoregional recurrence and 5-year cancer-specific survival.
  
  
  RESULTS
  There were 34 articles comprising 12 retrospective studies, nine prospective studies and 13 original articles including case series, observational studies and editorials. Of the prospective studies, four reported an increased lymph node harvest and a survival benefit. The others reported an improvement in the quality of the specimen as assessed by histopathological examination. Laparoscopic CME has the same oncological outcome as open surgery but completeness of excision during laparoscopy may be compromised for tumours in the transverse colon.
  
  
  CONCLUSIONS
  Studies demonstrate that CME removes significantly more tissue around the tumour including maximal lymph node clearance. There is little information on serious adverse events after CME and a long-term survival benefit has not been proved.
authors.affiliation: Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Kontovounisios
authors.forename: J
authors.initials: J
authors.lastname: Kinross
authors.forename: E
authors.initials: E
authors.lastname: Tan
authors.forename: G
authors.initials: G
authors.lastname: Brown
authors.forename: S
authors.initials: S
authors.lastname: Rasheed
authors.forename: P
authors.initials: P
authors.lastname: Tekkis
mesh_terms: D003082:Colectomy / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008646:Mesocolon / Q000601:surgery*; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Complete mesocolic excision; complete mesocolic resection; total mesocolic excision; total mesocolic resection