Minimally invasive procedures and basic surgical anatomy. / Complete mesocolic excision for right sided colon cancer.

Beschreibung

Complete mesocolic excision (CME) concept: embryonic layers and the extent of lymph node dissection. In this book you can find the phylosophy of the concept and precise methodology to its performing.
In the context of our topic, in colorectal cancer surgery, until the first decade of the 21st century, there were no such acute debates and periods of total enthusiasm for extended surgeries as seen in stomach or breast cancer. Right-sided hemicolectomy, interestingly, was considered a relatively straightforward procedure among others for colorectal cancer. What's intriguing is that precisely in 2009, exactly a hundred years after Jamieson and Dobson formulated the concept of mesenteric- oriented surgery for the large intestine in 1909, Professor Werner Hohenberger, along with colleagues from the surgical clinic at Friedrich-Alexander University in Erlangen, systematized their experience and presented the now globally recognized concept of complete mesocolic excision (CME). This concept, analogous to total mesorectal excision (TME), emphasizes not only the precision of embryonic layer dissection but also raises questions about the extent of lymph node dissection, which remains highly relevant. Despite the fact that historical controls were the only available design element at the time, it is worth noting that these were arguably the only systematic data on the outcomes of colorectal cancer surgery from representatives of Western surgery at that time, and these results were highly inspiring! Starting from this point, we can observe comprehensive exploration of both the oncological aspects of CME and the various techniques used to perform it, including traditional open, laparoscopic, robotic, and hybrid approaches, among others. While the feasibility of minimally invasive treatment is no longer a subject of significant debate today, the oncological benefits of expanding dissection boundaries in such intricate vascular environments remain a matter of limited understanding, as reflected in several ongoing prospective studies.

Autor*in

Yevgen Miroshnychenko
Assistant professor of surgery General and visceral surgery, surgical oncology, hepato-biliary surgery, endocrine surgery, surgical urology. «Minimally invasive techniques in colorectal surgery», director of program.

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