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, on behalf the CME Project Working Group, on behalf the CME Consensus Steering Group (SG), Patricia Tejedor, Nader Francis, David Jayne, Werner Hohenberger, Jim Khan, on behalf the CME Consensus Project Working Group (PWG), Anwar Ahmed, C. Abraham-Igwe, Charles L. Evans, Danilo Mišković, F. Pfeffer, Inna Tulina, John Calvin Coffey, Kenneth L. Campbell, Marcos Gómez-Ruiz, Nicholas P. West, Oliver C. Shihab, Paolo Bianchi, Peter Coyne, Petr Tsarkov, Philip L. Varghese, R W Motson, Roger Gerjy, Samson Tou, Talvinder Gill, Tsuyoshi Konishi, Volkan Özben, on behalf the CME Consensus Expert Group, Alberto Arezzo, Andrew R. L. Stevenson, A. Craig Lynch, Byung Soh Min, Carlos Pastor, Claus Anders Bertelsen, Dieter Hahnloser, Dejan Ignjatović, Giuseppe Spinoglio, Hermann Keßler, Hirotoshi Hasegawa, Koji Okabayashi, Luigi Boni, Mario Morino, Michael Leitz, Rogier M. P. H. Crolla, Roland S. Croner, Seon Hahn Kim, Sergey Efetov, Stefan Benz, Stefan Niebisch, Yves Panís, Wolfgang Hiller, Willem A. Bemelman
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.