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

Complete mesocolic excision and central vascular ligation in colorectal cancer in the era of minimally invasive surgery / Franceschilli, Marzia; DI CARLO, Sara; Vinci, Danilo; Sensi, Bruno; Siragusa, Leandro; Bellato, Vittoria; Caronna, Roberto; Rossi, Piero; Cavallaro, Giuseppe; Guida, Andrea; Sibio, Simone. - In: WORLD JOURNAL OF CLINICAL CASES. - ISSN 2307-8960. - 25:9(2021), pp. 0-8. [10.12998/wjcc.v9.i25.0000]

Complete mesocolic excision and central vascular ligation in colorectal cancer in the era of minimally invasive surgery

Sara Di Carlo;Vittoria Bellato;Roberto Caronna;Giuseppe Cavallaro;Simone Sibio
2021

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
2021
Complete mesenteric excision; central vascular ligation; colorectal cancer; lymphadenectomy; laparoscopy; minimally invasive surgery
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Complete mesocolic excision and central vascular ligation in colorectal cancer in the era of minimally invasive surgery / Franceschilli, Marzia; DI CARLO, Sara; Vinci, Danilo; Sensi, Bruno; Siragusa, Leandro; Bellato, Vittoria; Caronna, Roberto; Rossi, Piero; Cavallaro, Giuseppe; Guida, Andrea; Sibio, Simone. - In: WORLD JOURNAL OF CLINICAL CASES. - ISSN 2307-8960. - 25:9(2021), pp. 0-8. [10.12998/wjcc.v9.i25.0000]
File allegati a questo prodotto
File Dimensione Formato  
Caronna_Complete-mesocolic-excision_2021.pdf

accesso aperto

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Creative commons
Dimensione 3.38 MB
Formato Adobe PDF
3.38 MB Adobe PDF

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1566293
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 2
  • ???jsp.display-item.citation.isi??? 2
social impact