Abstract
Complete mesocolic excision (CME) with central vascular ligation (CVL) follows the same principles as the total mesorectal excision (TME) in the rectum of following the embryological planes for right‐sided cancers. The number of lymph nodes yielded increased with a resultant improvement in the oncological outcomes and by reducing local recurrence rates. Hohenberger's radical CME and CVL and the East's modified CME with D3 lymphadenectomy, which traditionally followed the embryological plane dissection for most of its intraabdominal cancer resection, have both shown to harvest significantly higher number of lymph nodes leading to a higher overall survival rate than the traditional right hemicolectomies of the West. To achieve the oncologically superior excision of the CME, awareness of the significant vascular anatomical variation will enhance the precision of the oncosurgery as well as minimize the risk of vascular complications. There has been an increasing body of evidence emerging on the safety of minimally invasive surgery (MIS); both its oncological safety as well as complication rates in the hands of expert and trained surgeons. The surgical technique of a CME right hemicolectomy is described step by step to aid standardization. There is mounting evidence that CME + CVL/ D3 improves survival in patients with colon cancer. Whilst the technical aspect of MIS is more challenging than the left, with a standardized technique and systematic teaching method, safety and benefits for patients can be achieved.
Highlights
The burden of colorectal cancer is increasing worldwide, and is currently the third most commonly diagnosed cancer and the fourth cause of cancer-related deaths.[1]
The incidence of colorectal cancer is considered a marker of cancer transition, with rapid societal and economic advances resulting in its increase
The Aim of this study is to describe a standardized technique and systematic teaching method to safely undertake a Complete mesocolic excision (CME) + central vascular ligation (CVL)/ D3 lymphadenectomy as mounting evidence suggests its superior benefit for patients with right-sided colon cancers
Summary
The burden of colorectal cancer is increasing worldwide, and is currently the third most commonly diagnosed cancer and the fourth cause of cancer-related deaths.[1]. | 235 side of the colon arises from the midgut, whilst the left arises from the hindgut. The transverse colon is composed of both structures, more from the midgut rather than the hindgut. Research and publications are pointing out the differences between cancers arising from the midgut and hindgut.[4] The right colon, arising from the midgut, tends to have more flat polyps than the left, which harbors the typical garden-type polyp. Right-sided tumors are more likely to develop in patients with a genetic predisposition, such as those within the Lynch syndrome or microsatellite instability mutation.[5] The differing responses to chemotherapy have been published in various studies,[6,7] with the right side fairing worse than cancers arising from the left side of the colon
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