The importance of the mesofascial interface in complete mesocolic excision

Complete mesocolic excision (CME) with Central Vascular Ligation (CVL) is progressively gaining acceptance as the most updated surgical treatment in the multimodal management of colonic cancer. The concept is based on excision of the affected organ with its related primitive dorsal mesenterium as an intact package to maximize local clearance, and high tie ligation to boost regional control, translating the original concept of Total Mesorectal Excision proposed by Heald for rectal cancer. Aim of this review is to analyze the modern concept of the mesenteric organ, with particular regard to the interfaces between its single components and the importance of the meso-fascial interface as the correct plane of separation. The integrity of the mesocolon excised along the meso-fascial interface (meso-fascial separation) prevents any breach of its surface and underlying structures, preserving the radial margin and the complex network of the meso-structure, avoiding any spillage of neoplastic cells within the surgical field. Central Vascular ligation allows for the most effective harvesting of lymph nodes, particularly of the apical ones, whose removal appears to be crucial in optimizing regional control. A surgical plane developed along the meso-fascial interface, coupled with high tie ligation, yields higher quality of surgical specimen, with better oncologic outcome in terms of local recurrence rate, disease-free and overall survival.