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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2016; 8(2): 106-114
Published online Feb 27, 2016. doi: 10.4240/wjgs.v8.i2.106
Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: A comprehensive review
Luca Maria Siani, Gianluca Garulli
Luca Maria Siani, Gianluca Garulli, Minimally Invasive General and Thoracic Surgery Unit, Azienda Unità Sanitaria Locale della Romagna - “Ceccarini Hospital”, 47838 Riccione, Italy
Author contributions: Siani LM contributed to study conception and design, and writed manuscript; Garulli G contributed to study conception and design.
Conflict-of-interest statement: The authors declare non conflict of interest or any financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Luca Maria Siani, MD, PhD, Minimally Invasive General and Thoracic Surgery Unit, Azienda Unità Sanitaria Locale della Romagna - “Ceccarini Hospital”, Via Frosinone, 1, 47838 Riccione, Italy. lucamaria.siani@gmail.com
Telephone: +39-348-4731768 Fax: +39-06-45448165
Received: April 27, 2015
Peer-review started: April 29, 2015
First decision: August 31, 2015
Revised: December 4, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: February 27, 2016
Abstract

Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail, focusing on the latest studies of the mesenteric organ, its dissection by mesofascial and retrofascial cleavage planes, and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen, yielded through mesocolic, intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence, overall and disease-free survival, according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence, which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection, laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery, with all the advantages of laparoscopic techniques, both in faster recovery and better immunological response. The importance of minimally invasive meso-resectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.

Keywords: Right sided colonic cancer, Complete mesocolic excision, Central vascular ligation, Laparoscopy, Quality of surgical specimen, Oncologic outcome

Core tip: Laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) is based on resection of the colon within its intact and inviolate mesocolon with high tie ligation, so to improve the quality of the resection specimen produced; up-to-date anatomo-embryological concepts are analyzed in detail, focusing on the latest studies of the mesenteric organ, its dissection by mesofascial and retrofascial cleavage planes, and questioning the need for a new terminology in colonic resections. The rationale behind the CME with CVL is explained and particular attention is paid to the current surgical techniques. The impact on local recurrence, disease-free and overall survival is reviewed. Current literature about laparoscopic CME with CVL demonstrated better quality of the surgical specimen produced and significant survival advantage when compared to standard non-mesocolic resections, stressing the importance of meso-resectional surgery, especially when performed with minimally invasive techniques: higher surgical quality, faster recovery and better immunological response may in fact contribute to better long term oncologic outcome.