Bae SU. Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy: Standardization of surgical technique. World J Gastrointest Surg 2025; 17(4): 103704 [DOI: 10.4240/wjgs.v17.i4.103704]
Corresponding Author of This Article
Sung Uk Bae, MD, PhD, Associate Professor, Department of Surgery, School of Medicine, Dongsan Medical Center, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu KS002, South Korea. sabiston0000@hanmail.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2025; 17(4): 103704 Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.103704
Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy: Standardization of surgical technique
Sung Uk Bae
Sung Uk Bae, Department of Surgery, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu KS002, South Korea
Author contributions: Bae SU designed and performed the research, analyzed the data, and wrote and revised the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sung Uk Bae, MD, PhD, Associate Professor, Department of Surgery, School of Medicine, Dongsan Medical Center, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu KS002, South Korea. sabiston0000@hanmail.net
Received: November 29, 2024 Revised: January 26, 2025 Accepted: February 24, 2025 Published online: April 27, 2025 Processing time: 121 Days and 19.4 Hours
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.
Core Tip: In this recently published manuscript, Yadav emphasized the complementary role of D3 lymphadenectomy, which enhances lymphatic drainage clearance, aligning with the goal of complete mesocolic excision (CME) to achieve R0 resection. The authors advocated for the global standardization of CME and its integration into surgical training to ensure equitable access and improved outcomes in patients with colon cancer. This underscores the role of CME as a cornerstone of modern oncological surgery, which is essential for achieving excellent colorectal cancer treatment.
