The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: Proceedings of a consensus conference

K. Søndenaa, P. Quirke, W. Hohenberger, K. Sugihara, H. Kobayashi, H. Kessler, G. Brown, V. Tudyka, A. D'Hoore, R. H. Kennedy, N. P. West, Seon Hahn Kim, R. Heald, K. E. Storli, A. Nesbakken, B. Moran

Research output: Contribution to journalReview article

77 Citations (Scopus)

Abstract

Background: It has been evident for a while that the result after resection for colon cancer may not have been optimal. Several years ago, this was showed by some leading surgeons in the USA but a concept of improving results was not consistently pursued. Later, surgeons in Europe and Japan have increasingly adopted the more radical principle of complete mesocolic excision (CME) as the optimal approach for colon cancer. The concept of CME is a similar philosophy to that of total mesorectal excision for rectal cancer and precise terminology and optimal surgery are key factors. Method: There are three essential components to CME. The main component involves a dissection between the mesenteric plane and the parietal fascia and removal of the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains all lymph nodes draining the tumour area (Hohenberger et al., Colorectal Disease 11:354-365, 2009; West et al., J Clin Oncol 28:272-278, 2009). The second component is a central vascular tie to completely remove all lymph nodes in the central (vertical) direction. The third component is resection of an adequate length of bowel to remove involved pericolic lymph nodes in the longitudinal direction. Result: The oncological rationale for CME and various technical aspects of the surgical management will be explored. Conclusion: The consensus conference agreed that there are sound oncological hypotheses for a more radical approach than has been common up to now. However, this may not necessarily apply in early stages of the tumour stage. Laparoscopic resection appears to be equally well suited for resection as open surgery.

Original languageEnglish
Pages (from-to)419-428
Number of pages10
JournalInternational Journal of Colorectal Disease
Volume29
Issue number4
DOIs
Publication statusPublished - 2014 Jan 1

Fingerprint

Laparoscopy
Colonic Neoplasms
Ligation
Blood Vessels
Lymph Nodes
Fascia
Mesentery
Peritoneum
Rectal Neoplasms
Terminology
Dissection
Colorectal Neoplasms
Japan
Neoplasms
Surgeons
Direction compound

Keywords

  • Colon cancer
  • Complete mesocolic excision
  • Laparoscopy
  • Lymph node metastasis
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery : Proceedings of a consensus conference. / Søndenaa, K.; Quirke, P.; Hohenberger, W.; Sugihara, K.; Kobayashi, H.; Kessler, H.; Brown, G.; Tudyka, V.; D'Hoore, A.; Kennedy, R. H.; West, N. P.; Kim, Seon Hahn; Heald, R.; Storli, K. E.; Nesbakken, A.; Moran, B.

In: International Journal of Colorectal Disease, Vol. 29, No. 4, 01.01.2014, p. 419-428.

Research output: Contribution to journalReview article

Søndenaa, K, Quirke, P, Hohenberger, W, Sugihara, K, Kobayashi, H, Kessler, H, Brown, G, Tudyka, V, D'Hoore, A, Kennedy, RH, West, NP, Kim, SH, Heald, R, Storli, KE, Nesbakken, A & Moran, B 2014, 'The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: Proceedings of a consensus conference', International Journal of Colorectal Disease, vol. 29, no. 4, pp. 419-428. https://doi.org/10.1007/s00384-013-1818-2
Søndenaa, K. ; Quirke, P. ; Hohenberger, W. ; Sugihara, K. ; Kobayashi, H. ; Kessler, H. ; Brown, G. ; Tudyka, V. ; D'Hoore, A. ; Kennedy, R. H. ; West, N. P. ; Kim, Seon Hahn ; Heald, R. ; Storli, K. E. ; Nesbakken, A. ; Moran, B. / The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery : Proceedings of a consensus conference. In: International Journal of Colorectal Disease. 2014 ; Vol. 29, No. 4. pp. 419-428.
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abstract = "Background: It has been evident for a while that the result after resection for colon cancer may not have been optimal. Several years ago, this was showed by some leading surgeons in the USA but a concept of improving results was not consistently pursued. Later, surgeons in Europe and Japan have increasingly adopted the more radical principle of complete mesocolic excision (CME) as the optimal approach for colon cancer. The concept of CME is a similar philosophy to that of total mesorectal excision for rectal cancer and precise terminology and optimal surgery are key factors. Method: There are three essential components to CME. The main component involves a dissection between the mesenteric plane and the parietal fascia and removal of the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains all lymph nodes draining the tumour area (Hohenberger et al., Colorectal Disease 11:354-365, 2009; West et al., J Clin Oncol 28:272-278, 2009). The second component is a central vascular tie to completely remove all lymph nodes in the central (vertical) direction. The third component is resection of an adequate length of bowel to remove involved pericolic lymph nodes in the longitudinal direction. Result: The oncological rationale for CME and various technical aspects of the surgical management will be explored. Conclusion: The consensus conference agreed that there are sound oncological hypotheses for a more radical approach than has been common up to now. However, this may not necessarily apply in early stages of the tumour stage. Laparoscopic resection appears to be equally well suited for resection as open surgery.",
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AU - Quirke, P.

AU - Hohenberger, W.

AU - Sugihara, K.

AU - Kobayashi, H.

AU - Kessler, H.

AU - Brown, G.

AU - Tudyka, V.

AU - D'Hoore, A.

AU - Kennedy, R. H.

AU - West, N. P.

AU - Kim, Seon Hahn

AU - Heald, R.

AU - Storli, K. E.

AU - Nesbakken, A.

AU - Moran, B.

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N2 - Background: It has been evident for a while that the result after resection for colon cancer may not have been optimal. Several years ago, this was showed by some leading surgeons in the USA but a concept of improving results was not consistently pursued. Later, surgeons in Europe and Japan have increasingly adopted the more radical principle of complete mesocolic excision (CME) as the optimal approach for colon cancer. The concept of CME is a similar philosophy to that of total mesorectal excision for rectal cancer and precise terminology and optimal surgery are key factors. Method: There are three essential components to CME. The main component involves a dissection between the mesenteric plane and the parietal fascia and removal of the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains all lymph nodes draining the tumour area (Hohenberger et al., Colorectal Disease 11:354-365, 2009; West et al., J Clin Oncol 28:272-278, 2009). The second component is a central vascular tie to completely remove all lymph nodes in the central (vertical) direction. The third component is resection of an adequate length of bowel to remove involved pericolic lymph nodes in the longitudinal direction. Result: The oncological rationale for CME and various technical aspects of the surgical management will be explored. Conclusion: The consensus conference agreed that there are sound oncological hypotheses for a more radical approach than has been common up to now. However, this may not necessarily apply in early stages of the tumour stage. Laparoscopic resection appears to be equally well suited for resection as open surgery.

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