Abstract
Colectomy for malignant tumors or unresectable benign tumors requires preoperative
planning based on cross-sectional imaging, consideration of neoadjuvant therapy, a
decision on the extent of lymphadenectomy, and comprehensive knowledge of the relevant
anatomy. Imaging review is critical for determining resectability and noting any aberrant
anatomy. Based on the imaging, neoadjuvant therapy should be considered for bulky
or locally advanced disease. The anatomical resection of the colon, mesentery, and
lymph node basins is performed in accordance with the concept of complete mesocolic
excision (CME), entailing the resection of the mesentery with visceral peritoneum
intact, appropriate proximal and distal margins taken en bloc, and high ligation of
the primary feeding vessels along which the lymph nodes are positioned. High ligation
of the colic arteries is part of a standard lymphadenectomy and is intended to address
possible micrometastatic nodal disease and proper staging for adjuvant therapy. Extended
lymphadenectomy in the form of CME with central vascular ligation is indicated for
patients with advanced T stage or clinical lymphadenopathy. Whether extended lymphadenectomy
should be performed routinely is subject to debate. In this article, we review the
indications and operative strategies for management of colon cancer in various locations
in the colon, as well as key considerations for minimally invasive colectomy and advanced
techniques such as CME with central vascular ligation.
Keywords
colectomy - colon cancer - complete mesocolic excision
