Complete mesocolic excision (CME) is a surgical technique which is used for the treatment of colon cancer. It involves complete removal of the diseased colon, mesocolon, and the associated blood vessels which supply blood to the cancerous cells. The mesocolon refers to the folded peritoneum that attaches the colon to the posterior abdominal wall.
Complete mesocolic excision (CME) requires a longer operative time as it is a challenging procedure. In one part of the surgery, the colon and mesocolon are removed from the peritoneum (a thin membrane which covers the abdominal organs). In the other part, the surgeon performs a central vascular ligation which involves tying the blood vessels together and completely removing the lymph nodes in a vertical (central) direction.
By removing the lymph nodes, the risk of spread of cancer into the peritoneum (abdomen) is minimized.
Indications for Complete Mesocolic Excision (CME)
Complete mesocolic excision (CME) is recommended for:
- Colon cancer
- Rectal cancer
Surgical Techniques for Complete Mesocolic Excision (CME)
Complete mesocolic excision (CME) can be performed through an open approach or via laparoscopic surgery. Care is taken that the correct blood vessels are identified.
Open Surgery
In this procedure, a “lateral-to-medial” approach is adopted. This means an incision is made in the side of your abdomen which extends to the centre.
- You will be administered general anaesthesia.
- An incision is made laterally and it continues over the duodenum and pancreas to reach the superior mesenteric vein (the blood vessel that drains blood from the small intestine) and the mesenteric artery that circulates blood from the aorta to the pancreas and the lower parts of the intestine.
- After the blood vessels have been identified, they are ligated (tied).
- Your surgeon then locates the site of cancer and removes the colon and mesocolon without damaging the adjoining tissues and organs.
- The incision is closed.
Laparoscopic Surgery
In this procedure, a “medial-to-lateral” approach is adopted. This means an incision is made into the colon which then extends to the side of your abdomen.
- You will be administered general anaesthesia.
- Your surgeon will make an incision into the colon and then the pancreas is identified.
- The important arteries and blood vessels supplying the pancreas and intestines are preserved. The remaining arteries that supply the cancerous cells are dissected (cut) and removed.
- The lymph nodes are also dissected and removed.
- The colon and mesocolon are removed.
- The incision is closed.
For removing colon cancer on the right side, a part of it is removed by making a mini-incision in the abdomen and extracorporeal anastomosis is performed.
- This means the branching blood vessels are connected manually.
For removing colon cancer on the left side, a part of it is removed by making a mini-incision in the umbilicus (belly button) and intracorporeal anastomosis is performed.
- This means the branching blood vessels are connected using a surgical stapler which is inserted into the body through the anal route.
Risks and Complications Associated with Complete Mesocolic Excision (CME)
Complete mesocolic excision is relatively complicated compared to conventional colectomy (colon removal) surgeries. It may be associated with the following risks:
- Increased risk of damage to the superior mesenteric vein and other arteries
- Altered blood flow which may lead to bowel ischemia: reduced blood flow to the intestines
- Genitourinary dysfunction
Advantages/Benefits of Complete Mesocolic Excision (CME)
Complete mesocolic excision offers the following benefits:
- It improves the survival rate of rectal/colon cancer patients.
- It reduces local recurrence rate.
