Implementing complete mesocolic excision for colon cancer - mission completed?

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Complete mesocolic excision (CME) has transformed colon cancer surgery.
• Minimally invasive surgical advancements are challenging the established role of CME.
• Understanding embryological anatomy is crucial for adapting CME to minimally invasive settings.

Purpose of the Study:

• To review the evolution of CME in colon cancer surgery.
• To compare outcomes of conventional surgery, open CME, and minimally invasive CME.
• To assess the safety and efficacy of CME in different surgical approaches.

Main Methods:

• Review of surgical outcomes including morbidity, mortality, and cancer-specific survival.
• Comparison of data from conventional surgery, open CME, and laparoscopic/robotic CME.
• Analysis of recurrence rates for stage UICC III colon cancer.

Main Results:

• Open CME shows comparable or improved survival rates versus non-CME.
• Minimally invasive CME (laparoscopic and robotic) demonstrates acceptable morbidity and mortality.
• Laparoscopic CME shows promising survival rates, though some data for stage UICC III suggest differences compared to open CME.

Conclusions:

• CME is a safe and effective surgical technique for colon carcinomas when performed by experienced surgeons.
• CME provides a significant survival benefit achievable through surgery alone.
• Standardization of minimally invasive CME through dedicated teaching programs is essential to maintain oncological quality and establish it as the standard of care.