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

作　　者：Marzia Franceschilli Sara Di Carlo Danilo Vinci Bruno Sensi Leandro Siragusa Vittoria Bellato Roberto Caronna Piero Rossi Giuseppe Cavallaro Andrea Guida Simone Sibio 

机构地区：[1]Department of Surgery,Minimally Invasive Unit,Tor Vergata University of Rome,Rome 00133,Italy [2]Department of Surgical Sciences,Unit of Pancreatic and Biliary Surgery,Sapienza University of Rome,Rome 00161,Italy [3]Department of Surgery P Valdoni,Unit of Oncologic and Minimally Invasive Surgery,Sapienza University of Rome,Rome 00161,Italy

出　　处：《World Journal of Clinical Cases》2021年第25期7297-7305,共9页世界临床病例杂志

摘　　要：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 analyzesresults of these procedures in terms of oncological outcomes, technical feasibilityand complexity, especially within the context of minimally invasive surgery.

关 键 词：Complete mesenteric excision Central vascular ligation Colorectal cancer LYMPHADENECTOMY Laparoscopy Minimally invasive surgery 

分 类 号：R735.34[医药卫生—肿瘤]