Challenge to the term “complete mesocolic excision”

During the last several years the term “complete mesocolic excision” (CME) has been brought to the center of our colorectal vernacular. This term is meant to be analogous to total mesorectal excision (TME). While total mesorectal excision has been globally accepted as the surgical standard due to improved oncologic outcomes complete mesocolic excision is not at that level of acceptance. While Hohenberger, West, and Kessler amongst others all advocate for CME, many other surgeons do not champion CME. Most recently, Professor Les Bokey and coworkers from the University of Western Sydney present their long term survival from patients operated on with what they term “anatomical dissection of the colon (ADC)”. The authors had undertaken 779 potentially curative resections and presented follow-up on these patients through the end of 2012. The authors reported a 2.1% local and 10.2% systemic recurrence rate and an overall survival rate of 76.2% including a cancer specific survival rate of 89.8%. The authors expressed surprise that “so few studies on CME have reported long term recurrence or survival. Moreover, they discussed the fact that the term “mesocolic plane surgery” and “complete mesocolic excision” are misleading. They state that these terms lead to confusion because they detract attention away from dissection along anatomic planes. They feel that the term “complete” mesocolic excision should be replaced by the phrase “anatomical dissection of the colon”. This article is quite interesting as it offers a historical perspective on both TME and CME. It also makes a very compelling case for accurate anatomic dissection rather than complete tissue extirpation. This timely topic will undoubtedly be the impetus for much dialogue and debate at scientific forums and in peer review journals during the coming years..