Is Laparoscopic Complete Mesocolic Excision and Central Vascular Ligation Really Necessary for All Patients With Right-Sided Colon Cancer?

Abstract

Colon cancer treatment is on the way to evolution over several decades. The minimally invasive surgery has improved postoperative short-term outcomes. Adjuvant chemotherapy has prolonged the survival of advanced colon cancer patients. Hohenberger proposed the noble concept of complete mesocolic excision (CME) which consists of 3 components: plane surgery, sufficient longitudinal bowel resection, and central vascular ligation (CVL). Mesocolic plane surgery shares the same surgical principle of total mesorectal excision, which is maintaining the intact mesothelial envelope. However, there remain debates about the extent of bowel resection and the level of CVL for maximizing lymph node dissection. There is no solid clinical evidence for the oncological necessity and benefit of extended radical dissection in right hemicolectomy. CME with CVL based on open surgery has been adopted in laparoscopic surgery. So, it is also necessary to look at how the CME could be transformed and successfully implanted in the laparoscopic era. Recent rapid advances in surgical technology and cancer biology are preparing for fundamental changes in cancer surgery. In this study, we reviewed the history, oncological necessity, and compatibility of CME for the right hemicolectomy in the laparoscopic era and outline the new perspectives on the evolution of cancer surgery.

Keywords: Colectomy; Colonic neoplasms; Laparoscopy; Lymph node excision; Mesocolon.

Fig. 1.

Grouping of the retrieved lymph nodes (LN). Adapted from Yang et al. [31], according to the Creative Commons License of open access.

Fig. 2.

Lymphatics of the right colon. a, superior mesenteric vein; b, superior mesenteric artery; c, main nodes; d, middle colic artery; e, middle colic vein; f, right colic artery and vein; g, ileocolic artery and vein; h, superior mesenteric node; i, Henle’s gastrocolic trunk; j, right gastroepiploic vein. Adapted from Toyota et al. [34], with permission of Wolters Kluwer Health, Inc.