Complete Mesocolic Excision and Extent of Lymphadenectomy for the Treatment of Colon Cancer

Curative-intent surgical resection of colon cancer involves optimal approaches to the peri-tumoral tissue, the mesocolon, and the draining lymph nodes. The key corresponding concepts that will be discussed are complete mesocolic excision (CME), central vascular ligation (CVL) or D3 dissection, and circumferential resection margin (CRM). We aim to describe these techniques and delineate evidence surrounding their technical feasibility, pathologic detail, as well as long-term oncologic impact. CME with CVL and D3 dissection are overlapping concepts both emphasizing anatomy-based resection of tumor and regional lymph nodes that does not breach the embryonic visceral fascia and ensures complete lymph node dissection up to the mesenteric root. Completeness of the mesocolic plane, number of harvested nodes, and CRM are surgical pathologic parameters that impact oncologic outcome. Attention to these details has been associated with improved outcomes in retrospective observational trials and the choice of open or minimally invasive approaches must be determined by surgeon ’s technical experiences.
Source: Surgical Oncology Clinics of North America - Category: Surgery Authors: Source Type: research