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. 2022 Aug;36(8):5595-5601.
doi: 10.1007/s00464-021-08395-0. Epub 2022 Jul 5.

Consensus statements on complete mesocolic excision for right-sided colon cancer-technical steps and training implications

Patricia Tejedor  1 , Nader Francis  2   3   4 , David Jayne  5 , Werner Hohenberger  6 , Jim Khan  7   8 ; on behalf the CME Project Working Group
Collaborators, Affiliations

Consensus statements on complete mesocolic excision for right-sided colon cancer-technical steps and training implications

Patricia Tejedor et al. Surg Endosc. 2022 Aug.

Abstract

Background: CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways.

Methods: Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus.

Results: Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme.

Conclusions: Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies.

Keywords: Complete mesocoloc excision; Expert consensus; Right colon cancer; Standardisation; Survival.

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Conflict of interest statement

Ms Patricia Tejedor, Prof Nader Francis, Prof David Jayne and Prof Werner Hohenberger have no conflicts of interest to disclose or financial ties to disclose. Mr Jim Khan is a proctor with Intuitive surgical.

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