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  3. Standardisation Before Radicality: Current Evidence For Complete Mesocolic Excision.
  1. Home
  3. Standardisation Before Radicality: Current Evidence For Complete Mesocolic Excision.

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Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection
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Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection

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Standardisation Before Radicality: Current Evidence for Complete Mesocolic Excision.

Kilian G M Brown1, Talia Shepherd2, Michael J Solomon1

  • 1Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|June 9, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

Complete mesocolic excision (CME) for right-sided colon cancer lacks clear definition and consistent oncologic benefit. High-quality D2 dissection is now the standard, with D3 dissection reserved for select cases.

Keywords:
D2 dissectioncomplete mesocolic excisionright colectomy

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Gastrointestinal Oncology

Background:

  • Complete mesocolic excision (CME) for right-sided colon cancer is poorly defined, leading to inconsistent application and unclear oncologic outcomes.
  • Heterogeneity in CME techniques and reliance on limited data hinder efficacy assessment.

Purpose of the Study:

  • To review current evidence on the oncologic efficacy of CME in right-sided colon cancer.
  • To clarify the role of CME versus standard dissection techniques.

Main Methods:

  • A narrative literature review of PubMed/MEDLINE identified studies on CME, central vascular ligation, D3 lymphadenectomy, and right hemicolectomy.
  • Emphasis was placed on prospective randomized trials to evaluate oncologic outcomes.

Main Results:

  • Many studies show improved outcomes with CME but often compare it to poorly defined conventional colectomy.
  • The RELARC trial, a high-quality randomized study, found no significant difference in survival between D2 dissection and CME/D3 dissection with standardized surgery.
  • Observed benefits in prior studies may stem from improved surgical quality rather than CME itself.

Conclusions:

  • The imprecise term "CME" should be replaced with explicit descriptions of lymphadenectomy extent.
  • High-quality D2 dissection is the standard of care for right colectomy.
  • Future efforts should focus on standardization, training, and quality improvement, with selective D3 dissection for specific patient groups.