Complete mesocolic excision for colon cancer: is it worth it?

Frederick H. Koh, Ker-Kan Tan


Total mesorectal excision (TME) has been the miracle surgical technique which has since allowed the outcomes of rectal cancer to surpass that of colon cancer. Complete mesocolic excision (CME) attempts to adopt the same principles as that of TME and apply it to colon cancer surgery. Initial retrospective case series and comparative studies have shown promising oncological outcomes. CME entails the en bloc removal of a sufficient length of colonic specimen within an intact peritoneal envelop with extended lymphadenectomy through a high central ligation of vessels. This technique, standardizing the method for resection of right sided colon cancer, has witness promising perioperative and oncological data for both open and laparoscopic methods. However, most data available are mostly retrospective with a glaring lack of level 1 evidence. Despite the technique showing similar outcomes to that of conventional colectomy, parts of the procedure put the patient (and surgeon) at risk of potentially catastrophic complications. As promising as the initial results of CME has been, more well-designed randomized control trials are necessary to justify the increased risks taken and effort to mount the learning curve for CME.