Complete mesocolic excision with central vascular ligation: is this the approach to improve colon cancer surgery oncological outcomes?

The concept of total mesorectal excision (TME) as proposed by Heald et al. (1) in the early 80’s resulted in significantly better oncological outcomes in rectal cancer surgery (1-3). TME also raised the issue of better outcomes in colon cancer surgery, which, until then, was not standardized and the reports in the literature displayed a great deal of heterogeneity and high recurrence rates (4-7). In 2009 and in parallel to the TME concept, came the first report and description of the complete mesocolic excision (CME) with central vascular ligation (CVL) from the Erlangen group of Hohenberger (8), with quite impressive oncological outcomes and an overall 5-year survival reaching up to 70% for stage III colon cancer patients. They also showed that it is a safe and feasible technique which bears at least the same morbidity and mortality as the “so called” standard technique (8).