Complete mesocolic excision and central vessel ligation for right colon cancers

Killeen, Shane; Keßler, Hermann

doi:10.1007/s10151-014-1214-0

Cited by 9 publications

(5 citation statements)

References 7 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to these guidelines, similarly to the principle of lymph node dissection for D2 lymph node dissection of gastric cancer and the TME procedure for rectal cancer, the medial border in CME for right-sided colon cancer must reach the median line of the SMA. Many surgeons in Western or Eastern countries follow this principle [5, 14, 19]. However, baring of the SMA and cleaning of its peripheral lymph nodes inevitably damage some autonomic nerves of the mesentery, which can lead to severe post-operative diarrhea and gastrointestinal dysfunction, and increase the risk of lymphatic leakage.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of laparoscopic radical right hemicolectomy with complete mesocolic excision using an ‘artery-first’ approach

et al. 2019

Gastroenterology Report

View full text Add to dashboard Cite

Background According to previous guidelines, the lymph nodes around the right side of the superior mesenteric artery (SMA) should be dissected and removed en bloc. However, due to the technical challenge and the risk of complications, most surgeons perform the dissection along the axis of the superior mesenteric vein (SMV). Herein, we described an ‘artery-first’ approach for laparoscopic radical extended right hemicolectomy with complete mesocolic excision (CME). Methods A total of 22 cases were collected from January to October 2016. The right side of the SMA and SMV were exposed and separated, and the No. 203, No. 213 and No. 223 lymph nodes were dissected en bloc. Toldt’s fascia was dissected and expanded laterally to the ascending colon, cranial to the pancreas head. The caudal root of the mesentery and lateral attachments of the ascending colon were completely mobilized. Results There were 9 male and 13 female patients, with a mean age of 63.1 (range, 39–83) years and the mean body mass index was 24.6 (range, 18.3–37.7) kg/m 2 . The mean operative time was 192.5 (range, 145–240) minutes and the mean intra-operative blood loss was 55.0 (range, 10–300) ml. The mean number of harvested lymph nodes was 27.0 (range, 13–55) and the time to flatus and hospital stay were 35.0 (range, 26–120) hours and 7.5 (range, 5–20) days, respectively. Minor complications occurred in two patients and no post-operative death was observed. Conclusions The preliminary results suggest that the reported approach may be a feasible and safe procedure that is more in accordance with the principles of CME.

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility and efficacy of laparoscopic radical right hemicolectomy with complete mesocolic excision using an ‘artery-first’ approach

et al. 2019

Gastroenterology Report

View full text Add to dashboard Cite

show abstract

“…To achieve these, one requires a clear perception of peritoneal, colonic, mesenteric and fascial anatomy [5,12,14] . As demonstrated earlier, each of these structures is contiguous from the mesenteric origin to the termination of the mesorectum [16] .…”

Section: Discussionmentioning

confidence: 99%

“…The central principles of mesenteric-based surgery (including complete mesocolic excision, total mesocolic excision and total mesorectal excision) are those of intact and extensive mesenterectomy [5,7,12,14] . To achieve these, one requires a clear perception of peritoneal, colonic, mesenteric and fascial anatomy [5,12,14] .…”

Section: Discussionmentioning

confidence: 99%

“…When the surgeon places it under stretch, by lifting it away from the retroperitoneum, the fascia can either be swept away from the colon, diathermy or sharply divided. By continuing this process, the colon is freed to the point where the mesofascial plane becomes apparent [14] . While this is self-evident, and separation has been practiced for well over one hundred years by gastrointestinal surgeons, the colo-fascial plane has been virtually ignored.…”

Section: The Colo-fascial Planementioning

confidence: 99%

See 1 more Smart Citation

Mesenteric-Based Surgery Exploits Gastrointestinal, Peritoneal, Mesenteric and Fascial Continuity from Duodenojejunal Flexure to the Anorectal Junction - A Review

et al. 2015

View full text Add to dashboard Cite

Introduction: It is now well established that mesenteric-based colorectal surgery is associated with superior outcomes. Recent anatomic observations have demonstrated that the mesenteric organ is contiguous from the duodenojejunal to the anorectal junction. This led to similar observations in relation to associated peritoneum and fascia. The aim of this review was to demonstrate the relevance of the contiguity principle to resectional colorectal surgery. Methods: All literature in relation to mesenteric anatomy was reviewed from 1873 to the present, without language restriction. Results: Mesenteric-based surgery (i.e. complete mesocolic excision, total mesocolic and mesorectal excision) requires division of the peritoneal reflection (i.e. peritonotomy), and mesenteric mobilisation in the mesofascial plane. These are the fundamental technical elements of mesenterectomy. Mesenteric, peritoneal and fascial contiguity mean that in resectional surgery, these technical elements can be reproducibly applied at all levels from the origin at the superior mesenteric root, to the anorectal junction. Conclusions: The goals of complete mesocolic, total mesocolic and mesorectal excision can be universally achieved at any level from duodenojejunal flexure to anorectal junction, by adopting technical elements based on mesenteric, peritoneal and fascial contiguity.

show abstract

“…Duodenal kocherization is not performed routinely in present study. The ileocolic vessels and the right colic vessels are divided from the superior mesenteric vessels at their origin [13]; then, the ileocolic vessels are separated from the superior mesenteric artery and vein. After, ligation of the ileocolic vessels is performed, and a lateral or medial approach to shape dissection is performed along Toldt's fascia.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Short-Term and Long-Term Outcomes of Complete Mesocolic Excision with Central Vascular Ligation for Ascending Colon Cancer: Single Institution

Jang¹,

Lim²,

Kuk³

et al. 2017

Surgery Curr Res

View full text Add to dashboard Cite

Purpose: The aim of the present study was to analyze the peri-and post-operative and oncologic outcomes for ascending colon cancer after complete mesocolic excision (CME) with central vessel ligation (CVL). Materials and methods:The data of 156 patients who underwent CME with CVL for ascending colon cancer between January 2000 and December 2011 were retrieved from a prospective database. Results:The median follow-up time was 63.6 months. The mean operation time was 191.6 min. The mean blood loss was 85.6 ml. The mean length of the hospital stay was 13.9 days. The mean number of total harvested lymph nodes was 30.3. A 5-year cancer-specific survival (CSS) rate was seen in 83.0% of patients, and a 5-year diseasefree survival (DFS) rate was seen in 79.7%. In stage I, the DFS and CSS rates were both 100%. In stage II, the DFS rate was 91.0% and the CSS rate was 92.3%. In stage III, the DFS rate was 53.5% and the CSS rate was 59.5%. In stage IIIa, the DFS and CSS rates were both 100%. In stage IIIb, the DFS rate was 70.1% and the CSS rate was 92.1%. In stage IIIc, the DFS rate was 19.4% and the CSS rate was 44.0% (p<0.01). The local recurrence rate was 3.8%. Conclusion:Based on the present data, CME with CVL is feasible and safe for treating ascending colon cancer. CME with CVL could lead to better oncologic outcomes for ascending colon cancer surgery.

show abstract

Complete mesocolic excision and central vessel ligation for right colon cancers

Cited by 9 publications

References 7 publications

Feasibility and efficacy of laparoscopic radical right hemicolectomy with complete mesocolic excision using an ‘artery-first’ approach

Feasibility and efficacy of laparoscopic radical right hemicolectomy with complete mesocolic excision using an ‘artery-first’ approach

Mesenteric-Based Surgery Exploits Gastrointestinal, Peritoneal, Mesenteric and Fascial Continuity from Duodenojejunal Flexure to the Anorectal Junction - A Review

Short-Term and Long-Term Outcomes of Complete Mesocolic Excision with Central Vascular Ligation for Ascending Colon Cancer: Single Institution

Contact Info

Product

Resources

About