EAES rapid guideline: complete mesocolic excision for right-sided colon cancer-with SAGES and ESCP participation

Stavros A Antoniou^{1

2}, Francesco Maria Carrano³, Alexander A Tzanis⁴, Konstantinos Perivoliotis⁵, Sunjay S Kumar⁶, Christos Christogiannis⁷, Dimitris Mavridis⁷, Bright Huo⁸, Nicole Bouvy⁹, Niki Christou¹⁰, Suzanne Dore¹¹, Audrius Dulskas¹², Christos Kontovounisios¹³, Tim Lubbers⁹, Francesco Palazzo⁵, Philip Quirke¹⁴, Dimitra Repana¹⁵, Monica Terlizzo¹⁶, Bethany J Slater¹⁷, Ivan D Florez^{18

19

20}, Monica Ortenzi²¹, Tan Arulampalam²²

Affiliations

¹ Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece. stavros.antoniou@hotmail.com.
² Guidelines Committee, European Association for Endoscopic Surgery, Eindhoven, Netherlands. stavros.antoniou@hotmail.com.
³ Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
⁴ 1 st Department of Obstetrics and Gynaecology, Alexandra University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁵ Department of Surgery, General Hospital of Volos, Volos, Greece.
⁶ Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁷ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
⁸ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada.
⁹ Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹⁰ Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.
¹¹ Patient Representative, Rayne, Essex, UK.
¹² National Cancer Center, Affiliate of Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
¹³ 2nd Surgical Department, Evangelismos General Hospital, Athens, Greece.
¹⁴ Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
¹⁵ School of Cancer and Pharmaceutical Sciences King's College London, New Hunt's House, Guy's Campus, London, UK.
¹⁶ Department of Pathology, The Royal Marsden NHS Foundation Trust, London, UK.
¹⁷ Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
¹⁸ Department of Pediatrics, University of Antioquia, Medellin, Colombia.
¹⁹ Pediatric Intensive Care Unit, Clínica Las Américas-AUNA, Medellin, Colombia.
²⁰ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
²¹ Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
²² School of Medicine, Anglia Ruskin University, Chelmsford, UK.

PMID: 40355740
DOI: 10.1007/s00464-025-11782-6

Practice Guideline

EAES rapid guideline: complete mesocolic excision for right-sided colon cancer-with SAGES and ESCP participation

Stavros A Antoniou et al. Surg Endosc. 2025 Jun.

. 2025 Jun;39(6):3474-3483.

doi: 10.1007/s00464-025-11782-6. Epub 2025 May 12.

Authors

Affiliations

¹ Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece. stavros.antoniou@hotmail.com.
² Guidelines Committee, European Association for Endoscopic Surgery, Eindhoven, Netherlands. stavros.antoniou@hotmail.com.
³ Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
⁴ 1 st Department of Obstetrics and Gynaecology, Alexandra University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
⁵ Department of Surgery, General Hospital of Volos, Volos, Greece.
⁶ Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁷ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
⁸ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada.
⁹ Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
¹⁰ Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.
¹¹ Patient Representative, Rayne, Essex, UK.
¹² National Cancer Center, Affiliate of Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania.
¹³ 2nd Surgical Department, Evangelismos General Hospital, Athens, Greece.
¹⁴ Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
¹⁵ School of Cancer and Pharmaceutical Sciences King's College London, New Hunt's House, Guy's Campus, London, UK.
¹⁶ Department of Pathology, The Royal Marsden NHS Foundation Trust, London, UK.
¹⁷ Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
¹⁸ Department of Pediatrics, University of Antioquia, Medellin, Colombia.
¹⁹ Pediatric Intensive Care Unit, Clínica Las Américas-AUNA, Medellin, Colombia.
²⁰ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
²¹ Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
²² School of Medicine, Anglia Ruskin University, Chelmsford, UK.

PMID: 40355740
DOI: 10.1007/s00464-025-11782-6

Abstract

Background: Complete mesocolic excision (CME) is a surgical technique that aims to improve oncological outcomes of right-sided colon cancer resections. However, CME's technical complexity, surgical risks, and need for specialized training, present challenges. Also, variations in technical aspects and implementation lead to inconsistent outcomes.

Objective: To develop evidence-informed clinical practice recommendations on complete mesocolic excision for right-sided colon cancer, aiming to address whether laparoscopic CME should be preferred over standard laparoscopic right hemicolectomy for right-sided colon cancer.

Methods: The present guideline adheres to GRADE, AGREE-S, and Cochrane standards, using MAGICapp for development. The steering group included colorectal and general surgeons, supported by a Guidelines International Network-certified lead guideline developer, trainee methodologists, systematic reviewers and statisticians. The guideline panel included surgeons, oncologists, a pathologist, and a patient partner. It provides recommendations based on a linked systematic review, appraisal of benefits and harms, the certainty of the evidence, patient values and preferences, acceptability, feasibility, use of resources, and equity.

Results: A conditional recommendation is issued in favor of CME for patients undergoing right hemicolectomy for right-sided colon cancer where expertise is available, based on low-to-moderate certainty evidence. The panel suggests CME is acceptable to stakeholders and feasible, despite potential equity issues due to variable expertise availability. There is insufficient evidence to recommend CME based on tumor location or cancer stage. A conditional recommendation means that the majority of well-informed patients, surgeons and other stakeholders, would opt for the recommended course of action, but discussion of relevant benefits and harms is advised prior to decisions. The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/EaG1dL .

Conclusions: This guideline provides evidence-informed recommendations on the management of right-sided colon cancer, developed in line with the highest quality methodological and reporting standards, and informed by an interdisciplinary panel of stakeholders.

Keywords: CME; Colon cancer; Complete mesocolic excision; Guideline; Right colectomy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Disclaimer: This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g., surgeons, anaesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g., surgical nurses, dieticians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by health care authorities (e.g., regional and national authorities, health care institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point in time. The information in the guideline should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time the guideline is developed and when it is published or read. The guideline is not continually updated and may not reflect the most recent evidence. The guideline addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This guideline does not mandate any particular course of medical care. Further, the guideline is not intended to substitute the independent professional judgment of the treating provider, as the guideline does not necessarily account for individual variation among patients. Even if evidence on a topic suggests a specific diagnostic and/or treatment action, users and especially health professionals may need to decide against the suggested or recommended action in view of circumstances related to patient values, preferences, co-morbidities and disease characteristics; available human, financial and material resources; and healthcare infrastructures. EAES provides this guideline on an “as is” basis, and makes no warranty, express or implied, regarding the guideline. Disclosures: Stavros A. Antoniou, Francesco Maria Carrano, Alexander A. Tzanis, Konstantinos Perivoliotis, Sunjay Kumar, Christos Christogiannis, Dimitris Mavridis, Bright Huo, Nicole Bouvy, Niki Christou, Suzanne Dore, Audrius Dulskas, Christos Kontovounisios, Tim Lubbers, Francesco Palazzo, Philip Quirke, Dimitra Repana, Monica Terlizzo, Bethany Slater, Ivan D. Florez, Monica Ortenzi, Tan Arulampalam and declare no direct conflicts of interest related to this work. Indirect conflicts of external advisors were documented and managed as per Guidelines International Network Standards. Detailed conflict of interest statements of all contributors can be found in the online appendix [22]. Ethical approval: Not applicable.

References

1. Tejedor P, Francis N, Jayne D, Hohenberger W, Khan J (2022) Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications. Surg Endosc 36:5595–5601. https://doi.org/10.1007/s00464-021-08395-0 - DOI - PubMed - PMC
1. Kong JC, Prabhakaran S, Choy KT, Larach JT, Heriot A, Warrier SK (2021) Oncological reasons for performing a complete mesocolic excision: a systematic review and meta-analysis. ANZ J Surg 91:124–131. https://doi.org/10.1111/ans.16518 - DOI - PubMed
1. Wang C, Gao Z, Shen Z, Jiang K, Zhou J, Wang S, Ye Y (2022) Five-year prognosis of complete mesocolic excision in patients with colon cancer: a prospective, nonrandomized, double-blind controlled trial. J Am Coll Surg 235:666–676. https://doi.org/10.1097/XCS.0000000000000282 - DOI - PubMed
1. Sica GS, Vinci D, Siragusa L, Sensi B, Guida AM, Bellato V, García-Granero Á, Pellino G (2023) Definition and reporting of lymphadenectomy and complete mesocolic excision for radical right colectomy: a systematic review. Surg Endosc 37:846–861 - DOI - PubMed
1. Schünemann H, Brożek J, Guyatt G, Oxman A (2013) GRADE handbook for grading quality of evidence and strength of recommendations

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
- Springer

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

EAES rapid guideline: complete mesocolic excision for right-sided colon cancer-with SAGES and ESCP participation

Affiliations

EAES rapid guideline: complete mesocolic excision for right-sided colon cancer-with SAGES and ESCP participation

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources