CME versus D3 Dissection for Colon Cancer

Over the past 30 years, rectal cancer surgery has been standardized by total mesorectal excision. More recently, some have suggested that colon cancer surgery should be standardized by complete mesocolic excision (CME) with central vascular ligation (CVL), especially in Western countries. Surgeons undertaking CME with CVL report optimal outcomes. Sharp dissection within the embryological plane and high vascular ligation at the vessel origin are essential. In Japan, a similar concept, D3 dissection, has been adopted for decades. Although both surgical procedures are similar, distinct differences exist. Some surgeons are confused about the principles and practice of these two procedures. As well as overviewing the theory behind CME with CVL and D3 dissection, the technical details of both procedures are described.