BACKGROUND: Complete mesocolic excision (CME) has been proposed as a refinement of oncological surgery for right-sided colon cancer, aiming to improve specimen quality, lymph node yield and oncological outcomes. However, its routine adoption remains controversial due to uncertainty regarding oncological benefit and concerns relating to technical complexity, training and service delivery. This position statement from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) examines the contemporary evidence surrounding CME and its role within modern management of right-sided colon cancer. METHODS: This position statement was produced by the authors who represent a range of views on CME surgery. It synthesises contemporary evidence from large cohort studies, recent randomised control trials and international guidelines to evaluate the role of CME compared with standard high-quality right hemicolectomy. RESULTS: CME is consistently associated with higher lymph node yields and improved specimen metrics, but studies demonstrating a definitive survival advantage remain limited. Randomised evidence does not support routine CME for all patients, although potential benefit exists in selected high-risk groups. Recent evidence suggests that surgical plane quality, rather than the extent of lymphadenectomy, may be the principal determinant of oncological outcomes. CME is technically demanding and may carry increased procedural risks, particularly related to central vascular dissection, although these may be mitigated through structured training and optimised perioperative planning. CONCLUSION: Routine use of CME for all right-sided colon cancers is not supported by current evidence. Standard high-quality right hemicolectomy should remain the default approach for most patients. Selective use of CME may be appropriate in physiologically fit patients with high-risk or anatomically complex disease, delivered within experienced units with appropriate training, audit and quality assurance frameworks. Future progress will depend on standardisation of surgical technique, objective assessment of specimen quality and biologically tailored treatment strategies.
Mason et al. (Fri,) studied this question.