ASCRS Ch37 - Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer
Chapter 37, "Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer," ASCRS Textbook of Colon and Rectal Surgery, 4th edition. Author: Patricia Sylla. Book pp. 643–662 (title page through References).
Textbook reference chapter (not primary literature), closing out Part III ("Malignant Disease") —
note: this conflicts with ASCRS Ch35 - Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy's
source page, which describes Ch35 as the first chapter of Part IV ("Benign and Miscellaneous
Conditions"); since Ch36/Ch37 fall numerically between them and are both malignant-disease-focused
(MIS technique for cancer surgery, CME/D3 lymphadenectomy), one of these two Part-boundary
attributions is likely wrong — probably the Ch35 one, given a PDF page-offset/part-divider-page
issue was discovered around that point in the ingest (see log.md). Flagged rather than silently
corrected; the Part label doesn't affect any clinical content. A
deep, single-topic dive into complete mesocolic excision (CME) with central vascular ligation (CVL)
and Japanese-style D1/D2/D3 lymphadenectomy for colon cancer, with heavy emphasis on minimally
invasive technique and the D2-vs-D3 dissection controversy. The wiki's existing
Colon Cancer Resection page already has a brief CME section (from
ASCRS Ch25 - Colon Cancer Surgical Treatment) that flagged "no RCT data" as an open item — this
chapter substantially deepens that topic and backs a new dedicated page,
Complete Mesocolic Excision with D3 Lymphadenectomy, given the depth of terminology, anatomy, and
outcomes evidence involved. See that page for full content. This source page captures the chapter's
structure and key findings at a glance.
Structure
- CME and extended lymphadenectomy definitions: Japanese D1/D2/D3(/D4) lymph node classification (Table 37.1, Fig. 37.1), and how "CME + CVL" (Western terminology) maps onto "D3 dissection" (Japanese terminology) — the chapter explicitly aligns terminology, defining "CME + CVL" as CME performed with radical lymphadenectomy corresponding to JSCCR D3.
- Anatomical considerations: variations in configuration of the gastrocolic trunk of Henle (GCT)/ gastro-pancreatico-colic trunk (GPCT), SMV tributaries, and arterial anatomy relative to the SMV — critical knowledge for safe D3 dissection.
- Techniques of MIS CME + D3 for right-sided/transverse and left-sided colon cancer: medial-to- lateral approach, SMV-first approach, retrofascial uncinate-first approach (Stefan Benz's open-book model, with a detailed 9-step protocol and "critical views" for quality assurance), lateral-to- medial approach, cranial-to-caudal approach.
- Quality indicators of CME resections: mesocolic-plane grading, lymph node count, specimen morphometry (Fig. 37.3), large/small bowel length.
- Rationale for CME adoption, impact on mesocolic dissection grade, lymph node harvest, central/ skip/occult node metastasis detection.
- Short-term and long-term outcomes of CME with D2 vs. D3 dissection, by country/registry (Japanese JSCCR registry, Danish Colorectal Cancer Group (DCCG), European ERCRC registry) and by trial (JCOG0404, ongoing Chinese RCTs — RELARC, SLRC, LCME — and the ongoing COLD trial).
- Conclusions: current evidence supports CME + D2 as standard of care, with CME + D3 reserved selectively for patients at high risk of central lymph node metastasis (based on preoperative imaging, tumor location, and/or clinical T-stage) — routine D3 use for all stage II/III colon cancer remains controversial pending better-designed, higher-level trials with standardized quality assessment.
Open items / gaps
- See Complete Mesocolic Excision with D3 Lymphadenectomy for the full chapter content and its own open items — this source page is intentionally a structural summary rather than a full transcription, to avoid duplicating that page's detail.