title: Complete mesocolic excision and central vascular ligation for colon cancer: Principle, anatomy, surgical technique, and outcomes.
abstract: Classic colon cancer surgery refers to a wide resection of the tumor-bearing segment and the lymphatics draining along the named artery. 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. Here, we discuss appropriate CME procedure with regard to the oncologic backgrounds, essential components, applied anatomy, laparoscopic technique, short-term, and oncologic outcomes. The introduction of CME has improved oncologic outcomes greatly in patients with colon cancer. The improved outcomes with CME can be attributed to underlying sound oncologic principles such as dissection through the proper plane of mesocolic excision, central vascular ligation, and sufficient length of proximal and distal margins. Thereby, CME technique can achieve en bloc removal of the diseased lesion with the increased amount of the colonic mesentery even though the length of for both bowel and mesentery resection remains a matter of debate. CME is a technically demanding operation thus, comprehensive understanding of the applied vascular anatomy is essential for successful CME. Favorable outcomes of open CME have been replicated with a laparoscopic approach. In future perspective, incorporating a structured education program on minimally invasive (laparoscopy or robot) CME would be beneficial.
authors: Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: namkyuk@yuhs.ac.
authors: Nam Kyu
authors: NK
authors: Kim
authors: Department of Surgery, Division of Colorectal Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea.
authors: Young Wan
authors: YW
authors: Kim
authors: Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors: Yoon Dae
authors: YD
authors: Han
authors: Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors: Min Soo
authors: MS
authors: Cho
authors: Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors: Hyuk
authors: H
authors: Hur
authors: Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors: Byung Soh
authors: BS
authors: Min
authors: Department of Surgery, Division of Colorectal Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors: Kang Young
authors: KY
authors: Lee
mesh_terms: D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods*; D008646:Mesocolon / Q000601:surgery*; D011379:Prognosis
keywords: Colonic neoplasms; Mesocolic excision; Morbidity; Survival rate