Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy: Standardization of surgical technique

Abstract

Surgical advancements have transformed colorectal cancer treatment, with complete mesocolic excision (CME) becoming a crucial method to guarantee oncological safety and effectiveness. The article by Yadav emphasized the significance of CME in attaining optimal resection margins, thorough lymph node dissection, and enhanced long-term survival rates. The adjunctive function of D3 lymphadenectomy, emphasizing the clearance of lymphatic drainage along the supplying vessels, was also addressed. CME with central vascular ligation, based on the principles of total mesorectal excision for rectal cancer, entails en bloc tumor resection and precise dissection along the embryological planes, thus diminishing recurrence and improving survival rates. The viability and safety of minimally invasive techniques, such as laparoscopic CME, have been confirmed; however, technical difficulties remain owing to the intricate vascular anatomy. Robotic-assisted surgery presents potential benefits, including accurate lymphatic dissection and intracorporeal anastomosis. However, evidence demonstrating its superiority over laparoscopic techniques is scarce owing to high costs and prolonged duration. This study promotes the global standardization of CME as an essential element of modern colorectal cancer surgery. CME epitomizes contemporary oncological practices, requiring widespread adoption to achieve superiority in colon cancer management.