Clin Colon Rectal Surg 2022; 35(04): 288-297
DOI: 10.1055/s-0042-1743430
Review Article

The Mesentery in Complete Mesocolic Excision

Jordan Fletcher
1   Department of Colorectal Surgery, St. Mark's Hospital, London, United Kingdom
,
Danilo Miskovic
1   Department of Colorectal Surgery, St. Mark's Hospital, London, United Kingdom
› Author Affiliations

Abstract

The following article summarizes technical aspects of how to operate in the mesentery during complete mesocolic excision (CME). Increasingly, CME is being adopted and as such it is important to establish the anatomical basis of the techniques involved. This review thus serves to provide that foundation and explains the surgical techniques built on it.



Publication History

Article published online:
10 August 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Søndenaa K, Quirke P, Hohenberger W. et al. 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. Int J Colorectal Dis 2014; 29 (04) 419-428
  • 2 Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Colorectal Dis 2009; 11 (04) 354-364 , discussion 364–365
  • 3 Miskovic D, Mirnezami R. Is complete mesocolic excision superior to conventional colectomy for colon cancer?. Lancet Oncol 2021; 22 (07) 917-918
  • 4 Crane J, Hamed M, Borucki JP, El-Hadi A, Shaikh I, Stearns AT. Complete mesocolic excision versus conventional surgery for colon cancer: a systematic review and meta-analysis. Colorectal Dis 2021; 23 (07) 1670-1686
  • 5 Bertelsen CA, Neuenschwander AU, Jansen JE. et al. 5-Year outcome after complete mesocolic excision for right-sided colon cancer: a population-based cohort study. Lancet Oncol 2019; 20 (11) 1556-1565
  • 6 Gao Z, Wang C, Cui Y. et al. Efficacy and safety of complete mesocolic excision in patients with colon cancer: three-year results from a prospective, nonrandomized, double-blind, controlled trial. Ann Surg 2020; 271 (03) 519-526
  • 7 West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 2008; 9 (09) 857-865
  • 8 Japanese Society of Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. 2nd ed.. Tokyo: Kanehara Shuppan Co. Ltd; 2009
  • 9 Kanemitsu Y, Komori K, Kimura K, Kato T. D3 lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum 2013; 56 (07) 815-824
  • 10 Kotake K, Mizuguchi T, Moritani K. et al. Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. Int J Colorectal Dis 2014; 29 (07) 847-852
  • 11 Hashiguchi Y, Hase K, Ueno H, Mochizuki H, Shinto E, Yamamoto J. Optimal margins and lymphadenectomy in colonic cancer surgery. Br J Surg 2011; 98 (08) 1171-1178
  • 12 Tan KY, Kawamura YJ, Mizokami K. et al. Distribution of the first metastatic lymph node in colon cancer and its clinical significance. Colorectal Dis 2010; 12 (01) 44-47
  • 13 Lu J-Y, Xu L, Xue H-D. et al. The radical extent of lymphadenectomy - D2 dissection versus complete mesocolic excision of LAparoscopic Right Colectomy for right-sided colon cancer (RELARC) trial: study protocol for a randomized controlled trial. Trials 2016; 17 (01) 582
  • 14 Xu L, Su X, He Z. et al; RELARC Study Group. Short-term outcomes of complete mesocolic excision versus D2 dissection in patients undergoing laparoscopic colectomy for right colon cancer (RELARC): a randomised, controlled, phase 3, superiority trial. Lancet Oncol 2021; 22 (03) 391-401
  • 15 Karachun A, Petrov A, Panaiotti L, Voschinin Y, Ovchinnikova T. Protocol for a multicentre randomized clinical trial comparing oncological outcomes of D2 versus D3 lymph node dissection in colonic cancer (COLD trial). BJS Open 2019; 3 (03) 288-298
  • 16 Karachun A, Panaiotti L, Chernikovskiy I. et al. Short-term outcomes of a multicentre randomized clinical trial comparing D2 versus D3 lymph node dissection for colonic cancer (COLD trial). Br J Surg 2020; 107 (05) 499-508
  • 17 Kaye TL, West NP, Jayne DG, Tolan DJ. CT assessment of right colonic arterial anatomy pre and post cancer resection - a potential marker for quality and extent of surgery?. Acta Radiol 2016; 57 (04) 394-400
  • 18 So JS, Cheong C, Oh SY, Lee JH, Kim YB, Suh KW. Accuracy of preoperative local staging of primary colorectal cancer by using computed tomography: reappraisal based on data collected at a highly organized cancer center. Ann Coloproctol 2017; 33 (05) 192-196
  • 19 Nerad E, Lahaye MJ, Maas M. et al. Diagnostic accuracy of CT for local staging of colon cancer: a systematic review and meta-analysis. AJR Am J Roentgenol 2016; 207 (05) 984-995
  • 20 Cavagnari MAV, Silva TD, Pereira MAH. et al. Impact of genetic mutations and nutritional status on the survival of patients with colorectal cancer. BMC Cancer 2019; 19 (01) 644
  • 21 Coffey JC, O'Leary DP. The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 2016; 1 (03) 238-247
  • 22 Treves F. Lectures on the anatomy of the intestinal canal and peritoneum in man. BMJ 1885; 1 (1262): 470-474
  • 23 Stocchi L. Complete mesocolic excision. Tech Coloproctol 2014; 18 (09) 773-774
  • 24 Schoenwolf GC, Larsen WJ. Development of the gastrointestinal tract. In: Larsen's Human Embryology. 4th ed.. Philadelphia, PA: Elsevier Churchill Livingstone; 2009: 435-477
  • 25 Coffey JC, Sehgal R, Knol J. Embryonic development of the mesentery, peritoneal reflection and Toldt's fascia. In: Coffey JC, Lavery I, Sehgal R. eds. Mesenteric Principles of Gastrointestinal Surgery: Basic and Applied Science. 1st ed.. Boca Raton, FL: CRC Press, Taylor and Francis Group; 2017: 41
  • 26 Liang J-T, Huang J, Chen T-C, Hung J-S. The Toldt fascia: a historic review and surgical implications in complete mesocolic excision for colon cancer. Asian J Surg 2019; 42 (01) 1-5
  • 27 Chesbrough RM, Burkhard TK, Martinez AJ, Burks DD. Gerota versus Zuckerkandl: the renal fascia revisited. Radiology 1989; 173 (03) 845-846
  • 28 Garcia-Granero A, Pellino G, Frasson M. et al. The fusion fascia of Fredet: an important embryological landmark for complete mesocolic excision and D3-lymphadenectomy in right colon cancer. Surg Endosc 2019; 33 (11) 3842-3850
  • 29 Coffey JC, Dockery P, Moran B, Heald R. Mesenteric and peritoneal anatomy. In: Coffey JC, Lavery I, Sehgal R. eds. Mesenteric Principles of Gastrointestinal Surgery: Basic and Applied Science. 1st ed.. Boca Raton, FL: CRC Press, Taylor and Francis Group; 2017: 11-39
  • 30 Negoi I, Beuran M, Hostiuc S, Negoi RI, Inoue Y. Surgical anatomy of the superior mesenteric vessels related to colon and pancreatic surgery: a systematic review and meta-analysis. Sci Rep 2018; 8 (01) 4184
  • 31 Kuzu MA, İsmail E, Çelik S. et al. Variations in the vascular anatomy of the right colon and implications for right-sided colon surgery. Dis Colon Rectum 2017; 60 (03) 290-298
  • 32 Gao Y, Lu Y. Variations of gastrocolic trunk of Henle and its significance in gastrocolic surgery. Gastroenterol Res Pract 2018; 2018: 3573680
  • 33 Athanasiou CD, Markides GA, Kotb A, Jia X, Gonsalves S, Miskovic D. Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Colorectal Dis 2016; 18 (07) O224-O235
  • 34 Strey CW, Wullstein C, Adamina M. et al. Laparoscopic right hemicolectomy with CME: standardization using the “critical view” concept. Surg Endosc 2018; 32 (12) 5021-5030
  • 35 Hodgdon T, Danrad R, Patel MJ. et al. Logistics of three-dimensional printing: primer for radiologists. Acad Radiol 2018; 25 (01) 40-51
  • 36 Cromeens BP, Ray WC, Hoehne B, Abayneh F, Adler B, Besner GE. Facilitating surgeon understanding of complex anatomy using a three-dimensional printed model. J Surg Res 2017; 216: 18-25
  • 37 Yang T, Lin S, Xie Q. et al. Impact of 3D printing technology on the comprehension of surgical liver anatomy. Surg Endosc 2019; 33 (02) 411-417
  • 38 Bücking TM, Hill ER, Robertson JL, Maneas E, Plumb AA, Nikitichev DI. From medical imaging data to 3D printed anatomical models. PLoS One 2017; 12 (05) e0178540
  • 39 Colorectal Disease Journal. Robotic right complete mesocolectomy with patient-specific 3D-modelling. Accessed: July 7, 2021 at: https://www.youtube.com/watch?v=ThF9hB8lYAg&t=85s
  • 40 Miyamoto R, Tadano S, Sano N, Inagawa S, Adachi S, Yamamoto M. The impact of three-dimensional reconstruction on laparoscopic-assisted surgery for right-sided colon cancer. Wideochir Inne Tech Malo Inwazyjne 2017; 12 (03) 251-256
  • 41 Garcia-Granero A, Sánchez-Guillén L, Fletcher-Sanfeliu D. et al. Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer. Tech Coloproctol 2018; 22 (02) 129-133
  • 42 Luzon JA, Andersen BT, Stimec BV. et al. Implementation of 3D printed superior mesenteric vascular models for surgical planning and/or navigation in right colectomy with extended D3 mesenterectomy: comparison of virtual and physical models to the anatomy found at surgery. Surg Endosc 2019; 33 (02) 567-575
  • 43 Willard C-D, Kjaestad E, Stimec BV, Edwin B, Ignjatovic D, Group RCCS. RCC Study Group. Preoperative anatomical road mapping reduces variability of operating time, estimated blood loss, and lymph node yield in right colectomy with extended D3 mesenterectomy for cancer. Int J Colorectal Dis 2019; 34 (01) 151-160
  • 44 ACTRN12620001378910. RoLaCaRT-1: a randomized trial of robotic surgery versus laparoscopic surgery for colon cancer. Available at: http://www.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12620001378910. John Wiley & Sons, Ltd.; 2021. Accessed: July 7, 2021