Abstract：
Complete mesocolic excision (CME), central vascular ligation (CVL) and D3 lymphadenectomy refers to mesocolic excision within an intact mesenteric fascia, ligation of the vascular origin, and removal of all lymph nodes along the arterial root. While denoting different techniques, the terms CME, CVL and D3 are often used interchangeably. This review aims to provide the most up-to-date summary on CME. A total of nine meta-analyses were published from 2020 to 2021, as well as preliminary results from three randomised trials. CME invariably resulted in a greater lymph node yield compared to non-CME surgery. Other quality indicators were poorly reported, including completeness of the mesocolic plane. CME improved short to long term survival outcomes. Three meta-analyses showed a reduction in local recurrence rates with CME, and one demonstrated improved incidence of distant recurrence. Analysis of the evidence suggests a benefit for routine CME surgery in all but the earliest colon cancers. CME was associated with a longer surgical duration but reduced operative blood loss. All but two meta-analyses showed no difference in overall complication rates with CME. While vascular, lymphatic and autonomic injury are potential concerns during CME, there was consistently no significant difference between the rates of anastomotic leakage and postoperative mortality as well as the duration of post-operative hospital stay between CME and conventional colectomy. Long-term bowel function and quality of life was similar between both techniques. A substantial learning curve exists for CME. Standardised training regimes are necessary for mastery of the technique to achieve the best outcomes.
摘要：
完整结肠系膜切除术（CME），中央血管结扎术（CVL）和D3淋巴结清扫术是指完整的肠系膜筋膜内的肠系膜切除术，血管起源的结扎，并切除沿动脉根部的所有淋巴结。虽然表示不同的技术，术语CME，CVL和D3通常可互换使用。这篇综述旨在提供有关CME的最新摘要。从2020年到2021年，共发表了9项荟萃分析，以及3项随机试验的初步结果。与非CME手术相比，CME总是导致更高的淋巴结产量。其他质量指标报告不佳，包括中庭平面的完整性。CME改善了短期到长期的生存结果。三项荟萃分析显示，CME降低了局部复发率，其中一项显示远处复发的发生率改善。证据分析表明，除最早的结肠癌外，常规CME手术对所有结肠癌都有好处。CME与更长的手术时间相关，但减少了手术失血。除两个荟萃分析外，所有荟萃分析均显示CME的总体并发症发生率无差异。而血管，淋巴和自主神经损伤是CME期间的潜在问题，CME和传统结肠切除术的吻合口漏发生率和术后死亡率以及术后住院时间均无显著差异.两种技术的长期肠功能和生活质量相似。CME存在大量的学习曲线。标准化的培训制度对于掌握技术以达到最佳效果是必要的。
