Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications

Patricia Tejedor; Nader Francis; David Jayne; Werner Hohenberger; Jim Khan; Anwar Ahmed; Chukwuma Abraham-Igwe; Charles Evans; Danilo Miskovic; Frank Pfeffer; Inna Tulina; John Calvin Coffey; Kenneth Campbell; Marcos Gómez-Ruiz; Nicholas Paul West; Oliver Shihab; Paolo Pietro Bianchi; Peter Edward Coyne; Petr Tsarkov; Philip Varghese; Roger W. Motson; Roger Gerjy; Samson Tou; Talvinder Singh Gill; Tsuyoshi Konishi; Volkan Ozben; Alberto Arezzo; Andrew R. L. Stevenson; Andrew Craig Lynch; Byung Soh Min; Carlos Pastor; Claus Anders Bertelsen; Dieter Hahnloser; Dejan Ignjatovic; Giuseppe Spinoglio; Hermann Kessler; Hirotoshi Hasegawa; Koji Okabayashi; Luigi Boni; Mario Morino; Michael R. Leitz; Rogier M. P. H. Crolla; Roland S. Croner; Seon Hahn Kim; Sergey K. Efetov

doi:10.1007/s00464-021-08395-0

Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications

Patricia Tejedor, Nader Francis, David Jayne, Werner Hohenberger, Jim Khan, Anwar Ahmed, Chukwuma Abraham-Igwe, Charles Evans, Danilo Miskovic, Frank Pfeffer, Inna Tulina, John Calvin Coffey, Kenneth Campbell, Marcos Gómez-Ruiz, Nicholas Paul West, Oliver Shihab, Paolo Pietro Bianchi, Peter Edward Coyne, Petr Tsarkov, Philip VargheseRoger W. Motson, Roger Gerjy, Samson Tou, Talvinder Singh Gill, Tsuyoshi Konishi, Volkan Ozben, Alberto Arezzo, Andrew R. L. Stevenson, Andrew Craig Lynch, Byung Soh Min, Carlos Pastor, Claus Anders Bertelsen, Dieter Hahnloser, Dejan Ignjatovic, Giuseppe Spinoglio, Hermann Kessler, Hirotoshi Hasegawa, Koji Okabayashi, Luigi Boni, Mario Morino, Michael R. Leitz, Rogier M. P. H. Crolla, Roland S. Croner, Seon Hahn Kim, Sergey K. Efetov

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Abstract

Background: CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways.

Methods: Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus.

Results: Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme.

Conclusions: Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies.

Original language	English
Pages (from-to)	5595-5601
Number of pages	7
Journal	Surgical Endoscopy
Volume	36
Issue number	8
Early online date	5 Jul 2022
DOIs	https://doi.org/10.1007/s00464-021-08395-0
Publication status	Published - 1 Aug 2022

Keywords

complete mesocoloc excision
right colon cancer
expert consensus
survival
standardisation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Consensus statementsFinal published version, 553 KBLicence: CC BY

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Tejedor, P., Francis, N., Jayne, D., Hohenberger, W., Khan, J., Ahmed, A., Abraham-Igwe, C., Evans, C., Miskovic, D., Pfeffer, F., Tulina, I., Coffey, J. C., Campbell, K., Gómez-Ruiz, M., West, N. P., Shihab, O., Bianchi, P. P., Coyne, P. E., Tsarkov, P., ... Efetov, S. K. (2022). Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications. Surgical Endoscopy, 36(8), 5595-5601. https://doi.org/10.1007/s00464-021-08395-0

@article{d05e3f82415247779010d3bb55dd96d5,

title = "Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications",

abstract = "Background: CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways.Methods: Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus.Results: Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme.Conclusions: Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies.",

keywords = "complete mesocoloc excision, right colon cancer, expert consensus, survival, standardisation",

author = "Patricia Tejedor and Nader Francis and David Jayne and Werner Hohenberger and Jim Khan and Anwar Ahmed and Chukwuma Abraham-Igwe and Charles Evans and Danilo Miskovic and Frank Pfeffer and Inna Tulina and Coffey, {John Calvin} and Kenneth Campbell and Marcos G{\'o}mez-Ruiz and West, {Nicholas Paul} and Oliver Shihab and Bianchi, {Paolo Pietro} and Coyne, {Peter Edward} and Petr Tsarkov and Philip Varghese and Motson, {Roger W.} and Roger Gerjy and Samson Tou and Gill, {Talvinder Singh} and Tsuyoshi Konishi and Volkan Ozben and Alberto Arezzo and Stevenson, {Andrew R. L.} and Lynch, {Andrew Craig} and Min, {Byung Soh} and Carlos Pastor and Bertelsen, {Claus Anders} and Dieter Hahnloser and Dejan Ignjatovic and Giuseppe Spinoglio and Hermann Kessler and Hirotoshi Hasegawa and Koji Okabayashi and Luigi Boni and Mario Morino and Leitz, {Michael R.} and Crolla, {Rogier M. P. H.} and Croner, {Roland S.} and Kim, {Seon Hahn} and Efetov, {Sergey K.}",

year = "2022",

month = aug,

day = "1",

doi = "10.1007/s00464-021-08395-0",

language = "English",

volume = "36",

pages = "5595--5601",

journal = "Surgical Endoscopy",

issn = "0930-2794",

publisher = "Springer New York",

number = "8",

}

Tejedor, P, Francis, N, Jayne, D, Hohenberger, W, Khan, J, Ahmed, A, Abraham-Igwe, C, Evans, C, Miskovic, D, Pfeffer, F, Tulina, I, Coffey, JC, Campbell, K, Gómez-Ruiz, M, West, NP, Shihab, O, Bianchi, PP, Coyne, PE, Tsarkov, P, Varghese, P, Motson, RW, Gerjy, R, Tou, S, Gill, TS, Konishi, T, Ozben, V, Arezzo, A, Stevenson, ARL, Lynch, AC, Min, BS, Pastor, C, Bertelsen, CA, Hahnloser, D, Ignjatovic, D, Spinoglio, G, Kessler, H, Hasegawa, H, Okabayashi, K, Boni, L, Morino, M, Leitz, MR, Crolla, RMPH, Croner, RS, Kim, SH & Efetov, SK 2022, 'Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications', Surgical Endoscopy, vol. 36, no. 8, pp. 5595-5601. https://doi.org/10.1007/s00464-021-08395-0

TY - JOUR

T1 - Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications

AU - Tejedor, Patricia

AU - Francis, Nader

AU - Jayne, David

AU - Hohenberger, Werner

AU - Khan, Jim

AU - Ahmed, Anwar

AU - Abraham-Igwe, Chukwuma

AU - Evans, Charles

AU - Miskovic, Danilo

AU - Pfeffer, Frank

AU - Tulina, Inna

AU - Coffey, John Calvin

AU - Campbell, Kenneth

AU - Gómez-Ruiz, Marcos

AU - West, Nicholas Paul

AU - Shihab, Oliver

AU - Bianchi, Paolo Pietro

AU - Coyne, Peter Edward

AU - Tsarkov, Petr

AU - Varghese, Philip

AU - Motson, Roger W.

AU - Gerjy, Roger

AU - Tou, Samson

AU - Gill, Talvinder Singh

AU - Konishi, Tsuyoshi

AU - Ozben, Volkan

AU - Arezzo, Alberto

AU - Stevenson, Andrew R. L.

AU - Lynch, Andrew Craig

AU - Min, Byung Soh

AU - Pastor, Carlos

AU - Bertelsen, Claus Anders

AU - Hahnloser, Dieter

AU - Ignjatovic, Dejan

AU - Spinoglio, Giuseppe

AU - Kessler, Hermann

AU - Hasegawa, Hirotoshi

AU - Okabayashi, Koji

AU - Boni, Luigi

AU - Morino, Mario

AU - Leitz, Michael R.

AU - Crolla, Rogier M. P. H.

AU - Croner, Roland S.

AU - Kim, Seon Hahn

AU - Efetov, Sergey K.

PY - 2022/8/1

Y1 - 2022/8/1

N2 - Background: CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways.Methods: Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus.Results: Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme.Conclusions: Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies.

AB - Background: CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways.Methods: Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus.Results: Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme.Conclusions: Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies.

KW - complete mesocoloc excision

KW - right colon cancer

KW - expert consensus

KW - survival

KW - standardisation

UR - https://link.springer.com/10.1007/s00464-021-08395-0

U2 - 10.1007/s00464-021-08395-0

DO - 10.1007/s00464-021-08395-0

M3 - Article

SN - 0930-2794

VL - 36

SP - 5595

EP - 5601

JO - Surgical Endoscopy

JF - Surgical Endoscopy

IS - 8

ER -

Consensus statements on complete mesocolic excision for right-sided colon cancer—technical steps and training implications

Abstract

Keywords

UN SDGs

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