Analysis of the national situation of right hemicolectomy with complete mesocolic excision in ascending and proximal traverse colon cancer

Abstract

Introduction

Complete mesocolic excision (CME) has been associated in some series with lower local recurrence and improvements in selected oncological outcomes in colon cancer, based on preservation of mesocolic integrity and central vascular ligation. In contrast, D3 lymphadenectomy (D3-LND) involves resection of lymphoadipose tissue adjacent to the superior mesenteric vein. Although both concepts coexist, they are not equivalent, which hampers outcome comparison and contributes to heterogeneity in clinical practice. In Spain, the extent of CME implementation has not been well characterized.

Methods

A descriptive cross-sectional study was conducted using an online survey addressed to Spanish centers performing oncological colon surgery. The questionnaire collected information on training pathways, surgical indication, technical approach, preoperative radiological planning, pathological assessment of the specimen, and the availability and recording of perioperative morbidity and long-term oncological follow-up.

Results

A total of 67 centers from across the country responded, 79% of which reported having a colorectal surgery unit. CME/D3-LND was performed in 52.2% of centers. Training was mainly based on literature review (49%) and mentorship (34.5%). Preoperative vascular anatomy was not systematically assessed in 61% of centers. Although 62% had pathologists specialized in colorectal cancer, only 18% had received specific training in CME. Approximately half of the respondents reported not having detailed information on procedure-related morbidity, and 86% did not know their long-term oncological outcomes.

Conclusions

CME implementation in Spain is heterogeneous and lacks uniform standardization regarding multidisciplinary training, preoperative planning, and pathological assessment. Despite the limitations inherent to a voluntary survey, this study provides a first national overview and highlights the need for consensus-based definitions and structured, multidisciplinary training programs to support a safer and more homogeneous implementation of CME.