Complete mesocolic excision for right colon cancer
Total mesorectal excision (TME) improves local recurrence rates and so it is accepted as the gold standard surgical method for locally advanced rectal cancer surgery. Based on these experiences, the concept of embryonic plane dissection was translated to surgery of colon cancer as complete mesocolic excision (CME) and central vascular ligation (CVL). CME aims to remove the specimen with an intact peritoneal tissue in according to embryonic planes and to ligate the vessels as close as possible to their separation point from the superior mesenteric vessels. With CME technique, more lymph nodes are harvested and better quality specimen is obtained. This procedure is feasible in both open and minimal invasive surgery, however, technical difficulties should not be overlooked. It is very important to learn correctly the anatomy and the embryology of right colon for successful resection. Many studies on this issue have significant limitations, being generally retrospective and non-homogeneous. There is no consensus on the routine implementation of CME due to the lack of prospective randomized controlled trials.