الفهرس 
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Abstract
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UMMARY
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
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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‖).
CME applies many of the same principles of the total mesorectal excision concept for rectal cancer to colon cancer surgery. Dissection along the ‗holy plane‘ at the mesorectal fascia has shown to minimize CRM involvement and is associated with improved outcomes in rectal cancer. Similarly, CME involves a meticulous dissection along the embryological planes surrounding the colon and its mesentery, resulting in an intact mesocolic envelope. CME also includes a division of the supplying vessels at their origin (CVL) to improve lymph node harvest.
There are several elements that are essential in CME surgery. First, the dissection is performed in the embryologic plane between the colonic mesentery and the parietal fascia of retroperitoneum. This allows for the removal of vascular, lymphatic, and perineural tissues as a complete undisturbed package en bloc with the colon. Second is CVL, where all the regional lymph nodes, including the apical or D3-level nodes, are removed with high ligation of the vascular pedicle. The third element is adequate bowel length of the resected specimen
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and the removal of the pericolic lymph nodes in the longitudinal direction.
The aim of this study is to perform a systematic review and meta-analysis to investigate safety and long-term out- comes of Complete Mesocolic Excision (CME) Versus Conventional RT Hemicolectomy (CRH) in patients with right sided colon cancer.
Five medical databases were used in this research: MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase. The keyword was as follows: ―complete mesocolic excision.‖ I select studies published up to December 2020. I select only articles written in English and we did not include abstracts or unpublished data.
My study confirm that CME with CVL associated with D3 lymphadectomy in right-side colon cancer improved not only staging but also prognosis, particularly in II and III stage; CME was a significant independent predictive factor for disease-specific survival at 3 years and 5 years compared with CRH associated with D2 lymphadectomy. CME is a safe and reproducible procedure with acceptable morbi-mortality.