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Review
. 2020 Jun;11(3):491-499.
doi: 10.21037/jgo.2019.11.08.

Minimally invasive complete mesocolic excision and central vascular ligation (CME/CVL) for right colon cancer

Ming Li Leonard Ho  1   2 , Tao-Wei Ke  1 , William Tzu-Liang Chen  1   3
Affiliations
Review

Minimally invasive complete mesocolic excision and central vascular ligation (CME/CVL) for right colon cancer

Ming Li Leonard Ho et al. J Gastrointest Oncol. 2020 Jun.

Abstract

Total mesorectal excision (TME) is the standard of care in rectal cancer surgery. Complete mesocolic excision and central vascular ligation (CME and CVL) are surgical concepts that are extrapolated from the principles of TME. Increasingly adopted by surgical units worldwide, laparoscopic CME/CVL for right sided colon cancer is a challenging procedure that requires meticulous dissection by the surgeon and detailed knowledge of the colonic vascular anatomy. This review article addresses the main issues pertaining to this surgical technique and also discusses steps on how to perform this operation safely.

Keywords: Laparoscopic surgery; central vascular ligation (CVL); colon cancer; complete mesocolic excision (CME).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo.2019.11.08). The series “Current Strategies in Colon Cancer Management” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Port placement for laparoscopic right hemicolectomy.
Figure 2
Figure 2
The terminal ileal mesentery is tented up and sharp dissection of the ileal mesentery from retroperitoneal fascia is performed.
Figure 3
Figure 3
Dissection in a cephalad direction along Toldt’s fascia with the exposure of more retroperitoneum. The right ureter can be seen at the bottom of the picture.
Figure 4
Figure 4
The medial extent of the dissection is formed by the C loop of duodenum and the pancreatic head.
Figure 5
Figure 5
The ileal vein is exposed. Tracing the course of the ileal vein towards the ileocolic vein will lead to the location of the SMV. SMV, superior mesenteric vein.
Figure 6
Figure 6
The avascular zone anterior to the SMV is dissected. Peritoneum and mesentery overlying the avascular zone can be divided safely. SMV, superior mesenteric vein.
Figure 7
Figure 7
The ileocolic vein is dissected free and demonstrated to be inserting into the SMV. Posterior to the ileocolic vein, the undissected ileocolic artery can be visualized. SMV, superior mesenteric vein.
Figure 8
Figure 8
The middle colic artery is demonstrated to arise from the SMA and has divided into its two branches. For this patient with ascending colon cancer, the surgeon proceeded to ligate only the right branch of middle colic artery. SMA, superior mesenteric artery.
Figure 9
Figure 9
Completion of CVL. Adequate exposure of the duodenum/pancreas during the initial stage of mobilization will reduce the risk of injury to them during CVL. CVL, central vascular ligation.
Figure 10
Figure 10
Creation of anti-peristaltic ileocolic anastomosis.
Figure 11
Figure 11
Ileo-colotomy closure using laparoscopic stapler. The surgeon may opt to perform this step by suturing, usually in two layers.
Figure 12
Figure 12
Anastomosis completed.
See this image and copyright information in PMC

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