Complete Mesocolic Excision (CME) Versus Conventional RT Hemicolectomy (CRH) in Patients with Right Sided Colon Cancer: A Systematic review and Meta-analysis

Abstract

olorectal cancer is the second- and third-most common cancer in women and men, respectively. In 2012, 614,000 women (9.2% of all new cancer cases) and 746,000 men (10.0% of new cancer cases) were diagnosed with colorectal cancer worldwide. Combined, in both sexes, colorectal cancer is the third-most common cancer and accounts for 9.7% of all cancers excluding non-melanoma skin cancer. More than half of the cases occur in more-developed regions of world. The age-standardized incidence rate (ASRi) of colorectal cancer is higher in men (20.6 per 100,000 individuals) than in women (14.3 per 100,000). The majority of patients with sporadic cancer are >50 years of age, with 75% of patients with rectal cancer and 80% of patients with colon cancer patients being ≥60 years of age at the time of diagnosis. It is necessary to understand the anatomical properties of mesocolon for describing CME. Carl Toldt showed that there is an extra fascial plane between the mesocolon and retroperitoneum and called it as “Toldt’s Fascia”. He defined three points: (I) Mesocolon starts at ileocecal level and continues up to rectosigmoid level; (II) Mesocolon of the transvers colon and the mobile part of sigmoid mesocolon does not include “Toldt’s Fascia”. Rest of the mesocolon (ascending, descending, non-mobile part sigmoid colon’s) are apposed to the retroperitoneum and “Toldt’s Fascia” is defined in these places; (III) confluence of sigmoid mesocolon and mesorectum is the inception of proximal rectum. Three surgical interfaces between two contiguous structures were described by Heald: (I) “Colo-fascial interface” (confluence of colonic surface and “Toldt’s Fascia”); (II) “Meso-fascial interface” (confluence of mesocolon and “Toldt’s Fascia”); (III) “Retro-fascial interface” (confluence of retroperitoneum and “Toldt’s Fascia”).