Complete mesocolic excision with central supplying vessel ligation - new technique in colon cancer treatment

Abstract

The basis of complete mesocolic excision represents the continuation and the conceptual idea of the total mesorectal excision of rectum (TME) which was described and promoted by R. J. Heald in 1983, and the point is to make the excision of the contaminated portion of the colon with the tumor in his visceral (embryonic) sheath without any damages of the central ligature of supplying vessels and preservation of the autonomous nervous system. According to this concept, colon and rectum, in their embryonic genesis, were belted on both sides with visceral fascia, as an envelope and through mesocolon, there was vascular and lymphatic drainage, while the ligature at the source of the vascular pedicle provided the removal of the largest number of lymphatic nodes. Surgical, sharp dissection, i.e. separation of visceral fasciae of the colon from the parietal peritoneum without any damage and total mobilization of the entire mesocolon with ligation in the very source of the supplying blood vessels. The scope of surgical mobilization of mesocolon is defined by the tumor localization. Literature provides numerous data supporting the fact that such technique enables the reduction in number of local recidives from 6.5% to 3.6% and increase of the five-year survival from 82.1% to 89%. CME technique provides optimal treatment of the colon cancer. © 2010, Oncology Institute of Vojvodina, Sremska Kamenica.