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 languageEnglish
Pages (from-to)5595-5601
Number of pages7
JournalSurgical Endoscopy
Volume36
Issue number8
Early online date5 Jul 2022
DOIs
Publication statusPublished - 1 Aug 2022

Keywords

  • complete mesocoloc excision
  • right colon cancer
  • expert consensus
  • survival
  • standardisation

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