The Role of Complete Mesocolic Excision in Colon Cancer Surgery

Abstract

Introduction: Complete mesocolic excision (CME) with central vascular ligation has been proposed to improve outcomes in right-sided colon cancer by ensuring thorough lymphadenectomy. This review evaluates whether CME improves oncologic outcomes over standard colectomy.

Methods: A literature search was performed in Embase and PubMed for studies comparing CME versus conventional colectomy. Primary endpoint was disease-free survival. Secondary endpoints included lymph node yield, R0 resection rate, and morbidity.

Results: Twenty-six observational studies and two small randomized trials were identified. CME consistently yielded more harvested lymph nodes (mean difference ten to fifteen nodes) and higher R0 resection rates. Five-year disease-free survival was improved in most studies, with hazard ratios ranging from 0.6 to 0.8. However, morbidity, particularly vascular injury and ureteral damage, was higher in early experience series.

Discussion: The improved survival likely results from more complete removal of tumor-draining lymphatics and prevention of “skip” metastases. The mesocolic plane is embryologically distinct from the mesorectal plane, making CME technically demanding. Standardization through training programs and use of defined anatomical landmarks reduces complications. Long-term survival benefits appear most pronounced for stage II and III disease.

Conclusions: Complete mesocolic excision improves lymph node harvest and disease-free survival in right colon cancer, albeit with a learning curve. Adoption should be accompanied by structured training.