Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14301
Revised: April 7, 2014
Accepted: June 12, 2014
Published online: October 21, 2014
Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.
Core tip: In specialised units, complete mesocolic excision is shown to improve pathological parameters as well as improve overall survival, disease free survival and reduce local recurrence. Yet many western units have not taken up the technique. This article explores reasons for and against complete mesocolic excision (CME) as well as D3 lymphadenectomy and the feasibility of laparoscopic CME.