Published online Feb 27, 2016. doi: 10.4240/wjgs.v8.i2.106
Peer-review started: April 29, 2015
First decision: August 31, 2015
Revised: December 4, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: February 27, 2016
Aim of the study is to comprehensively review the latest trends in laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) for the multimodal management of right colon cancer. Historical and up-to-date anatomo-embryological concepts are analyzed in detail, focusing on the latest studies of the mesenteric organ, its dissection by mesofascial and retrofascial cleavage planes, and questioning the need for a new terminology in colonic resections. The rationale behind Laparoscopic CME with CVL is thoroughly investigated and explained. Attention is paid to the current surgical techniques and the quality of the surgical specimen, yielded through mesocolic, intramesocolic and muscularis propria plane of surgery. We evaluate the impact on long term oncologic outcome in terms of local recurrence, overall and disease-free survival, according to the plane of resection achieved. Conclusions are drawn on the basis of the available evidence, which suggests a pivotal role of laparoscopic CME with CVL in the multimodal management of right sided colonic cancer: performed in the right mesocolic plane of resection, laparoscopic CME with CVL demonstrates better oncologic results when compared to standard non-mesocolic planes of surgery, with all the advantages of laparoscopic techniques, both in faster recovery and better immunological response. The importance of minimally invasive meso-resectional surgery is thus stressed and highlighted as the new frontier for a modern laparoscopic total right mesocolectomy.
Core tip: Laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) is based on resection of the colon within its intact and inviolate mesocolon with high tie ligation, so to improve the quality of the resection specimen produced; up-to-date anatomo-embryological concepts are analyzed in detail, focusing on the latest studies of the mesenteric organ, its dissection by mesofascial and retrofascial cleavage planes, and questioning the need for a new terminology in colonic resections. The rationale behind the CME with CVL is explained and particular attention is paid to the current surgical techniques. The impact on local recurrence, disease-free and overall survival is reviewed. Current literature about laparoscopic CME with CVL demonstrated better quality of the surgical specimen produced and significant survival advantage when compared to standard non-mesocolic resections, stressing the importance of meso-resectional surgery, especially when performed with minimally invasive techniques: higher surgical quality, faster recovery and better immunological response may in fact contribute to better long term oncologic outcome.