Surgical anatomy for complete mesocolic excision

Background: Complete mesocolic excision (CME) is a complex and technically challenging surgical procedure. Detailed knowledge of the anatomy underlying the principles of CME is mandatory. Objectives: Description of the embryology, topography, vascularization, lymphatic drainage and innervation of the colon. Practical relevance of the colon anatomy for CME. Methods: Appraisal of historical and current literature, description of anatomical variations, discussion of CME-related concepts. Results: All colonic segments are embryologically equipped with a mesocolon secondarily attached to the retroperitoneum and upper gastrointestinal (GI) organs. By detaching these adhesions along the mesocolic fascia (mesofascial interface) an intact mesocolic package can be mobilized. The superior mesenteric artery, left and middle colic arteries are relatively constant vessels, whereas the right colic artery displays considerable variations. The peculiarity of right-sided colic veins consists of a common confluence together with veins from the greater gastric curvature and pancreatic head into the gastropancreaticocolic trunk (Henle’s trunk) in ca. 80%. The lymphatic drainage is centripetal along the gut axis and may also involve upper GI organs by traversing predefined compartments. Also in CME attention has to be paid to preserve autonomic nerves. Conclusion: The outlined details, peculiarities and variations of the anatomy of the colon are prerequisites for a technically accurate CME according to the oncological requirements. © 2017, Springer Medizin Verlag GmbH.