Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
Department of Colorectal Surgery, Yeovil District Hospital, Yeovil, UK.
Surg Endosc. 2022 Aug;36(8):5595-5601. doi: 10.1007/s00464-021-08395-0. Epub 2022 Jul 5.
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.
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.
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.
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.
CME 是结肠癌的根治性切除术，但该手术技术要求高，操作差异较大。因此，需要采用标准化方法来优化技术和培训，以最大程度地减少技术风险并促进安全的推广。目的是就右半结肠和横结肠癌的完整结肠系膜切除术（CME）的最佳技术达成专家共识，以指导安全实施和培训途径。
采用改良 Delphi 法，从代表 18 个国家的 55 名 CME 和外科教育方面的国际专家中征求意见，制定指南。制定了领域主题，并将其细分为与 CME 实践的不同方面相关的问题。对基于特定问题的 25 项声明进行三轮 Delphi 投票，以 70%的共识率作为共识。
达成了 23 项 CME 程序建议，描述了该技术和最佳培训途径。CME 被推荐为局部晚期结肠癌的标准治疗性切除术。其基本内容包括中央血管结扎、肠系膜上静脉显露和完整结肠系膜切除。执行安全 CME 解剖的关键解剖标志包括识别回结肠蒂、肠系膜上静脉和结肠系膜根部。提出了基于能力的 CME 多模式培训课程，包括正式的指导计划。
专家组就完整结肠系膜切除术的技术和培训框架的标准化达成了共识，以指导当前的实践，并为未来的研究提供质量控制框架。
