Laparoscopic surgery with total mesocolic excision in colon cancer. A systematic review of the literature.

PURPOSE: Nowadays, there is no standardization in surgical procedures for treatment of colon cancer. Since its introduction, laparoscopic surgery has gained increasing interest in colorectal surgery and it is now performed worldwide for treatment of colon cancer. Following the concept of total mesocolic excision introduced by Heald in 1988 in order to reduce local recurrence after surgical treatment of mid/low rectal tumors, the idea of complete removal of the mesocolon mesocolic envelope has been developed also for colon cancer, has evolved longtime and complete mesocolic excision has been recently adopted as the optimal approach for colon cancer. However, complete mesocolic excision, whose purpose is to remove all lymphatics and lymph nodes draining the tumor, is still discussed as far as oncologic results are concerned. Moreover, the role of laparoscopic approach for complete removal of mesocolon has to be defined. METHODS: Selection of studies. A MEDLINE-PubMed database search of the current English Literature was performed using the terms: complete mesocolic excision; high vascular ligation; splenic flexure mobilization. INCLUSION CRITERIA: The inclusion criteria were report on CME for colonic cancer with high vascular ligation; minimum number of patients included (20 patients). Two independent reviewers (CRS, IE) extracted the data. RESULTS AND CONCLUSION: In this article, an update from the Literature on results of complete mesocolic excision was undertaken and data have been discussed. The role of laparoscopic complete mesocolic excision in colon cancer patients has been focused, and it seems to be safe and feasible, it should be standardized and hypothetical oncologic advantages should be expected. KEY WORDS: Colorectal-tumor, Complete mesocolic excision, High vascular ligation, Laparoscopic colorectal surgery, Splenic flexure mobilization, Total mesocolic excision.