REVIEW  COLON SURGERY 

Minerva Chirurgica 2019 April;74(2):148-59

DOI: 10.23736/S0026-4733.18.07777-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Complete mesocolic excision for colonic cancer

Abe FINGERHUT ¹ ✉, William TZU-LIANG CHEN ², Luigi BONI ³, Selman URANUES ¹

¹ Section for Surgical Research, Department of Surgery, University of Graz, Graz, Austria; ² Department of Colorectal Surgery, China University, Tai Chung, Taiwan; ³ Department of Surgery IRCCS, Ca’ Granda Policlinico Hospital, University of Milan, Milan, Italy

INTRODUCTION: Complete mesocolic excision for colonic cancer is similar in concept to total mesorectal excision for rectal cancer. This review aims to provide the embryological and anatomical rationale behind CME, and to review the current literature on CME, relative to the feasibility via laparoscopy, the oncological adequacy and outcomes.
EVIDENCE ACQUISITION: A literature search was performed at the end of 2017 according the PRISMA guidelines for systematic reviews. Of 3980 articles found, we analyzed 96 articles. Of note, many case series had overlapping populations; there were five review articles, two consensus conference proceedings, six comparative but only one randomized trial.
EVIDENCE SYNTHESIS: The embryonic and anatomical rationale is well described. CME is feasible via laparoscopy, which may facilitate dissection and anatomic precision: no statistically significant differences were found when compared to open CME regarding overall survival. However, morbidity may be higher in the hands of non-expert laparoscopic surgeons.
CONCLUSIONS: Oncological adequacy can be obtained with laparoscopic CME, with increased lymph node retrieval. However, until now, there is no formal proof that CME improves local recurrence or survival.

KEY WORDS: Laparoscopy - Colonic neoplasms - Embryology - Consensus