Laparoscopic complete mesocolic excision: West meets East.

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Colorectal Cancer Research

Background:

• Complete mesocolic excision (CME) is analogous to total mesorectal excision (TME) and has demonstrated positive pathological outcomes and survival benefits.
• Despite evidence of improved survival and reduced local recurrence, CME adoption in Western countries lags behind TME, with some units questioning its benefits due to technical complexity and limited supporting literature.

Purpose of the Study:

• To review the risks and benefits of complete mesocolic excision (CME) for colon cancer.
• To investigate the reasons behind the slow uptake of CME in Western surgical practice.
• To compare CME with D3 lymphadenectomy and explore the role of laparoscopy in CME.

Main Methods:

• Literature review of complete mesocolic excision (CME) for colon cancer.
• Analysis of outcomes data from units performing CME.
• Comparison of CME with D3 lymphadenectomy, considering data from Eastern surgical practices.

Main Results:

• Units performing CME report favorable pathological results and improvements in overall survival, disease-free survival, and local recurrence rates.
• The uptake of CME in the West has been slow, with skepticism regarding its benefits versus the increased technical challenge and potential morbidity.
• D3 lymphadenectomy has been standard for stage II and III colon cancers in many Asian countries for over two decades.

Conclusions:

• Further evidence synthesis, potentially by integrating data on CME and D3 lymphadenectomy from Eastern and Western cohorts, is needed to establish the universal necessity of CME.
• Lessons learned from Asian colleagues regarding D3 lymphadenectomy and CME could inform Western surgical practices and potentially accelerate the adoption of CME.
• The technical aspects and potential benefits of laparoscopic CME warrant further investigation to address concerns about morbidity and facilitate wider implementation.