Complete mesocolic excision for colonic cancer.

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Complete mesocolic excision (CME) is analogous to total mesorectal excision in rectal cancer surgery.
• Understanding the embryological and anatomical basis of CME is crucial for its application in colonic cancer treatment.

Purpose of the Study:

• To review the embryological and anatomical rationale for CME.
• To evaluate the current literature on laparoscopic CME regarding feasibility, oncological adequacy, and patient outcomes.

Main Methods:

• A systematic literature search was conducted following PRISMA guidelines up to December 2017.
• Analysis of 96 selected articles from an initial pool of 3980, including reviews, consensus proceedings, comparative studies, and one randomized trial.

Main Results:

• The embryological and anatomical rationale for CME is well-established.
• Laparoscopic CME is feasible and may enhance dissection precision, with no significant difference in overall survival compared to open CME.
• Morbidity may be higher with laparoscopic CME in non-expert hands.

Conclusions:

• Laparoscopic CME can achieve oncological adequacy, evidenced by increased lymph node retrieval.
• Formal evidence demonstrating that CME improves local recurrence or survival rates is currently lacking.