Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7297-7305
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7297
Complete mesocolic excision and central vascular ligation in colorectal cancer in the era of minimally invasive surgery
Marzia Franceschilli, Sara Di Carlo, Danilo Vinci, Bruno Sensi, Leandro Siragusa, Vittoria Bellato, Roberto Caronna, Piero Rossi, Giuseppe Cavallaro, Andrea Guida, Simone Sibio
Marzia Franceschilli, Sara Di Carlo, Danilo Vinci, Bruno Sensi, Leandro Siragusa, Vittoria Bellato, Piero Rossi, Andrea Guida, Department of Surgery, Minimally Invasive Unit, Tor Vergata University of Rome, Rome 00133, Italy
Roberto Caronna, Department of Surgical Sciences, Unit of Pancreatic and Biliary Surgery, Sapienza University of Rome, Rome 00161, Italy
Giuseppe Cavallaro, Simone Sibio, Department of Surgery P Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Rome 00161, Italy
Author contributions: Franceschilli M and Di Carlo S wrote the manuscript; Vinci D, Siragusa L, and Caronna R revised the draft; Sensi B edited the English grammar; Bellato V, Rossi P and Guida A performed the literature search; Cavallaro G and Sibio S critically reviewed the manuscript and approved the final version.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Simone Sibio, MD, PhD, Associate Professor, Surgical Oncologist, Department of Surgery P Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Viale del Policlinico 155, Rome 00161, Italy. simone.sibio@uniroma1.it
Received: March 16, 2021
Peer-review started: March 24, 2021
First decision: May 1, 2021
Revised: May 14, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 6, 2021
Processing time: 167 Days and 16.1 Hours
Abstract

Since the 19th century, appropriate lymphadenectomy has been considered a cornerstone of oncologic surgery and one of the most important prognostic factors. This approach can be applied to any surgery for gastrointestinal cancer. During surgery for colon and rectal cancer, an adequate portion of the mesentery is removed together with the segment of bowel affected by the disease. The adequate number of lymph nodes to be removed is standardized and reported by several guidelines. It is mandatory to determine the appropriate extent of lymphadenectomy and to balance its oncological benefits with the increased morbidity associated with its execution in cancer patients. Our review focuses on the concept of “complete mesenteric excision (CME) with central vascular ligation (CVL),” a radical lymphadenectomy for colorectal cancer that has gained increasing interest in recent years. The aim of this study was to evaluate the evolution of this approach over the years, its potential oncologic benefits and potential risks, and the improvements offered by laparoscopic techniques. Theoretical advantages of CME are improved local-relapse rates due to complete removal of the intact mesocolic fascia and improved distance recurrence rates due to ligation of vessels at their origin (CVL) which guarantees removal of a larger number of lymph nodes. The development and worldwide diffusion of laparoscopic techniques minimized postoperative trauma in oncologic surgery, providing the same oncologic results as open surgery. This has been widely applied to colorectal cancer surgery; however, CME entails a technical complexity that can limit its wide minimally-invasive application. This review analyzes results of these procedures in terms of oncological outcomes, technical feasibility and complexity, especially within the context of minimally invasive surgery.

Keywords: Complete mesenteric excision; Central vascular ligation; Colorectal cancer; Lymphadenectomy; Laparoscopy; Minimally invasive surgery

Core Tip: An optimal lymphadenectomy is the cornerstone of oncologic surgery. The concept of “optimal” or “adequate” relies on the balance between oncologic advantages and increased morbidity. The extent of lymphadenectomy in colorectal cancer surgery is a highly debated issue. The concept of “central vascular ligation” and “complete mesocolic excision” for radical lymphadenectomy in the era of minimally invasive surgery for colorectal cancer have been investigated.