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Complete Mesocolic Excision

Christoph Werner Strey, Christoph Wullstein, Michel Adamina, Ayman Agha, Heiko Aselmann, Thomas Becker, Robert Grützmann, Werner Kneist, Matthias Maak, Benno Mann, Kurt Thomas Moesta, Norbert Runkel, Clemens Schafmayer, Andreas Türler, Thilo Wedel, Stefan Benz
BACKGROUND: Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable. METHODS: An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME...
October 15, 2018: Surgical Endoscopy
Eiji Shinto, Jin-Ichi Hida, Hideyuki Ike, Hirotoshi Kobayashi, Yojiro Hashiguchi, Kazuo Hase, Hideki Ueno, Kenichi Sugihara
BACKGROUND: Complete mesocolic excision is becoming popular in colon cancer surgery in Western countries, and in the tumor-node-metastasis (TNM) classification of rectal cancer, a part of the lateral pelvic lymph nodes is classified as regional. However, the appropriateness of TNM staging according to the assessment of nodal status exclusively by extended lymphadenectomy remains unclear. PATIENTS AND METHODS: Using a nationwide multicenter database in Japan, we retrospectively analyzed 6866 patients with stage III colorectal cancer (CRC) treated with extended (D3) dissection...
October 1, 2018: Annals of Surgical Oncology
Qingyong Chen, Xiaoming Shuai, Libo Chen
OBJECTIVE: To explore the safety and feasibility of the combined medial and caudal approach in laparoscopic D3 lymphadenectomy plus complete mesocolic excision(CME) for right hemicolectomy in the treatment of right hemicolon cancer complicated with incomplete ileus. METHODS: Clinical data of 65 patients with incomplete obstructive right-sided colon cancer (T1 to 4M0) diagnosed by abdominal CT enhanced scan or MRI and/or electric colonscope undergoing laparoscopic right hemicolectomy (D3 lymphadenectomy + CME) at Department of Emergency Medicine and Department of Gastrointestinal Surgery from June 2014 to June 2017 were retrospectively analyzed...
September 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Giuseppe Spinoglio, Paolo P Bianchi, Alessandra Marano, Fabio Priora, Luca M Lenti, Ferruccio Ravazzoni, Wanda Petz, Simona Borin, Dario Ribero, Giampaolo Formisano, Emilio Bertani
BACKGROUND: During the past decade, the concept of complete mesocolic excision (CME) has emerged as a possible strategy to minimize recurrence for right colon cancers. The purpose of this study was to compare robotic versus laparoscopic CME in performing right colectomy for cancer. METHODS: Pertinent data of all patients who underwent robotic or laparoscopic right colectomy with CME using a Pfannenstiel incision and intracorporeal anastomosis performed between October 2005 and November 2015 were entered in a prospectively maintained database...
September 14, 2018: Annals of Surgical Oncology
Xiangbing Deng, Tao Hu, Mingtian Wei, Qingbin Wu, Tinghan Yang, Wenjian Meng, Ziqiang Wang
BACKGROUND: Complete mesocolic excision (CME) with central ligation or D3 lymphadenectomy has been reported to provide increased lymph node retrieval with the prospect of superior oncological results in colon cancer. However, right hemicolectomy with CME or D3 lymphadenectomy by laparoscopy is considered to be a technically challenging and time-consuming procedure with a higher risk of causing intraoperative injuries. Here, we introduce a novel laparoscopic approach for the D3 right hemicolectomy and report its feasibility, safety, and efficacy in cancer clearance...
September 2018: Langenbeck's Archives of Surgery
Noura Alhassan, Mei Yang, Nathalie Wong-Chong, A Sender Liberman, Patrick Charlebois, Barry Stein, Gerald M Fried, Lawrence Lee
BACKGROUND: Complete mesocolic excision (CME) is advocated based on oncologic superiority, but not commonly performed in North America. Many data are case series with few comparative studies. Our aim was to perform a systematic review comparing outcomes between CME and non-CME colectomy. METHODS: A systematic review was performed according to PRISMA guidelines of MEDLINE, EMBASE, HealthStar, Web of Science, and Cochrane Library. Studies were included if they compared conventional resection (non-CME) to CME for colon cancer...
September 12, 2018: Surgical Endoscopy
Mohamed Abdelkhalek, Ahmed Setit, Francesco Bianco, Andrea Belli, Adel Denewer, Tamer Fady Youssef, Armando Falato, Giovanni Maria Romano
PURPOSE: Revolutions have occurred over the last 3 decades in the management of patients with colorectal cancer. Most advances were in rectal cancer surgery, especially after the introduction of the total mesorectal excision (TME) by Heald. However, no parallel advances regarding colon cancer surgeries have occurred. In 2009, Hohenberger introduced a new concept trying to translate the survival advantages of TME to patients with colon cancer. This relatively new concept of a complete mesocolic excision (CME) with central vascular ligation (CVL) in the management of patients with colon cancer represents an evolution in operative technique...
August 2018: Annals of Coloproctology
Hyeong-Rok Kim
No abstract text is available yet for this article.
August 2018: Annals of Coloproctology
Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek, Nam Kyu Kim
No abstract text is available yet for this article.
October 2018: Diseases of the Colon and Rectum
B Furnes, K E Storli, H M Forsmo, A Karliczek, G E Eide, F Pfeffer
BACKGROUND: Rectal cancer surgery is standardized, resulting in improved survival. Colon cancer has fallen behind and therefore more radical surgical techniques have been introduced. One technique is complete mesocolic excision. The aim of this article was to study the complications after the introduction of standardized complete mesocolic excision in a single center. METHODS: Complete mesocolic excision was introduced in 2007, and data were collected from 286 patients prior to surgery (2007-2010)...
September 6, 2018: Scandinavian Journal of Surgery: SJS
Dimosthenis Chrysikos, Markos Sgantzos, John Tsiaoussis, Theodoros Piperos, Alexandra Varlatzidou, Vasileios Bonatsos, Panagiotis Theodoropoulos, George Noussios, Theodore Troupis, Ioannis Papapanagiotou, Theodoros Mariolis-Sapsakos
Right or subtotal colectomy either open or laparoscopic may be a challenging operation owing to technical difficulties. One of these, is to identify a safe and adequate dissection plane, ligating and dissecting lymph nodes around middle colic vessels. The purpose of this study was to depict a rare anatomic variation of middle colic vein (MCV) draining to splenic vein. We report the case of a 55-year-old male patient, who was subjected to a right hemicolectomy for an adenocarcinoma in the ascending colon. During dissecting the transverse mesocolon from the greater omentum, for complete mesocolic excision (CME), we encountered that the MCV drained in the splenic vein...
August 2018: Journal of Surgical Case Reports
Zhidong Gao, Chao Wang, Yancheng Cui, Zhanlong Shen, Kewei Jiang, Danhua Shen, Yi Wang, Siyan Zhan, Peng Guo, Xiaodong Yang, Fangfang Liu, Kai Shen, Bin Liang, Mujun Yin, Qiwei Xie, Youli Wang, Shan Wang, Yingjiang Ye
OBJECTIVE: The aim of the study was to evaluate the oncological outcomes of complete mesocolic excision (CME) in colon cancer patients. SUMMARY BACKGROUND DATA: CME is considered a standard procedure for colon cancer patients. However, previous evidence regarding the effect of CME on prognosis has fundamental limitations that prevent it from being fully accepted. METHODS: Patients who underwent radical resection for colon cancer were enrolled between November 2012 and March 2016...
August 24, 2018: Annals of Surgery
Dechang Diao, Jin Wan, Xiaojiang Yi, Xinquan Lu, Wei Wang, Hongming Li, Wenjun Xiong, Yaobin He
OBJECTIVE: To explore the feasibility and application value of the preservation of vegetative nervous functions in radical resection for right-sided colon cancer. METHODS: Clinical data of 55 cases with right-sided colon cancer undergoing laparoscopic D3+ complete mesocolic excision (CME) radical resection from January 2016 to July 2017 at Department of Gastrointestinal Surgery of Guangdong Province Hospital of Traditional Chinese Medicine were retrospectively analyzed...
August 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Y Xiao
Laparoscopic right colectomy by the rule of complete mesocolic excision is becoming a standard operation for right colon cancer. Intraoperative iatrogenic vascular injuries are rare but disastrous complications. In addition to the dissection along the embryonic plane, reducing iatrogenic bleeding is of crucial importance to safeguard the surgical procedure. Keeping the operative field clear by gentle suction to have a good exposure is essential to identify the origin of bleeding, and then to make decision how to control the bleeding by bipolar coagulation, clipping and transection, suturing or conversion to open surgery...
August 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Claus Anders Bertelsen, Helene M Larsen, Anders U Neuenschwander, Søren Laurberg, Bent Kristensen, Katrine J Emmertsen
BACKGROUND: Complete mesocolic excision improves the long-term outcome of colon cancer but might carry a risk of bowel dysfunction. OBJECTIVE: This study aimed to investigate whether right-sided complete mesocolic excision is associated with an increased risk of long-term bowel dysfunction and reduced quality of life compared with conventional colon cancer resections. DESIGN: Data were extracted from a population-based study comparing complete mesocolic excision and conventional colon cancer resections and from a national questionnaire survey regarding functional outcome...
September 2018: Diseases of the Colon and Rectum
I Hamzaoglu, V Ozben, I Sapci, E Aytac, A Aghayeva, I A Bilgin, I E Bayraktar, B Baca, T Karahasanoglu
BACKGROUND: Proper identification of the mesocolic vessels is essential for achieving complete mesocolic excision (CME) in cases of colon cancer requiring an extended right hemicolectomy. In robotic procedures, we employed a "top down technique" to allow early identification of the gastrocolic trunk and middle colic vessels. The aim of our study was to illustrate the details of this technique in a series of 12 patients. METHODS: The top down technique consists of two steps...
August 2018: Techniques in Coloproctology
Giuseppe Spinoglio, Wanda Petz, Simona Borin, Alessandra N Piccioli, Emilio Bertani
BACKGROUND: Robotic complete mesocolic excision (CME) has recently emerged as promising technique to enhance oncologic results in hemicolectomy for cancer. The potential near-infrared (NIR) fluorescence with indocyanine-green (ICG) dye for lymphatic mapping is under investigation and few small case-series are reported. METHODS: ICG solution was endoscopically injected the day before surgery in patients undergoing robotic right colectomy with CME using the Da Vinci Xi® system and the bottom to up technique...
July 23, 2018: Minerva Chirurgica
Abe Fingerhut, William T Chen, Luigi Boni, Selman Uranues
INTRODUCTION: Complete mesocolic excision for colonic cancer is similar in concept to total mesorectal excision for rectal cancer. This review aims to provide the embryological and anatomical rationale behind CME, and to review the current literature on CME, relative to the feasibility via laparoscopy, the oncological adequacy and outcomes. EVIDENCE ACQUISITION: A literature search was performed at the end of 2017 according the PRISMA guidelines for systematic reviews...
July 23, 2018: Minerva Chirurgica
Rosario Vecchio, Eva Intagliata, Salvatore Marchese, Renato Catalano
PURPOSE: Nowadays, there is no standardization in surgical procedures for treatment of colon cancer. Since its introduction, laparoscopic surgery has gained increasing interest in colorectal surgery and it is now performed worldwide for treatment of colon cancer. Following the concept of total mesocolic excision introduced by Heald in 1988 in order to reduce local recurrence after surgical treatment of mid/low rectal tumors, the idea of complete removal of the mesocolon mesocolic envelope has been developed also for colon cancer, has evolved longtime and complete mesocolic excision has been recently adopted as the optimal approach for colon cancer...
June 26, 2018: Annali Italiani di Chirurgia
Jarek Kobiela, Emilio Bertani, Wanda Petz, Cristiano Crosta, Giuseppe De Roberto, Simona Borin, Dario Ribero, Diana Baldassari, Piotr Spychalski, Giuseppe Spinoglio
In robotic right hemicolectomy for colorectal cancer (CRC), appropriate lymphadenectomy and anastomotic leak prevention are critical. Visualisation of lymph nodes and blood flow with near-infrared (NIR) fluorescence DaVinci® imaging system is a recent development. Herein, we present an improved robotic modified complete mesocolic excision (mCME) technique using indocyanine green (ICG) fluorescence. Before surgery, ICG is injected into the submucosa around the tumour with endoscopy for intraoperative detection of lymph nodes...
June 27, 2018: Journal of Minimal Access Surgery
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