Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-021-08395-0 Consensus statements on complete mesocolic excision for right‑sided colon cancer—technical steps and training implications Patricia Tejedor 1  · Nader Francis 2,3,4  · David Jayne 5  · Werner Hohenberger 6  · Jim Khan 1,7  · on behalf the CME Project Working Group Received: 26 September 2020 / Accepted: 9 February 2021 © Crown 2022 Abstract Background CME is a radical resection for colon cancer, but the procedure is technically demanding with signifcant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways. Methods Guidance was developed following a modifed Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to diferent aspects of CME practice. A three-round Delphi voting on 25 statements based on the specifc questions and 70% agreement was considered as consensus. Results Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomi- cal landmarks to perform a safe CME dissection include identifcation of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A profciency-based multimodal training curriculum for CME was proposed including a formal proctorship programme. Conclusions Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies. Keywords Complete mesocoloc excision · Right colon cancer · Expert consensus · Survival · Standardisation Outcomes for patients with rectal cancer have improved fol- lowing the acceptance of Total Mesorectal Excision (TME) surgery [1], whilst outcomes for patients with colonic can- cer have remained fairly static. Right-sided colon cancers are associated with worse 5-year overall survival for stage II and III disease compared to rectal cancer [2]. This may be contributed to the variability of the technique of right hemicolectomy and the lack of standardisation of the oncol- ogy sound resection. Hohenberger was the frst to publish and Other Interventional Techniques Patricia Tejedor and Nader Francis have shared frst authorship to the manuscript. Collaborators of the of the CME Project Working Group are listed in “Acknowledgment”. * Jim Khan Jim.khan@porthosp.nhs.uk 1 Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth PO6 3LY, UK 2 Department of Colorectal Surgery, Yeovil District Hospital, Yeovil, UK 3 Division of Surgery and Interventional Science, University College London, London, UK 4 Training Directorate At Grifn Institute Northwick Park Institute for Medical Research, London, UK 5 Leeds Institute of Medical Research At St James’s, University of Leeds, Leeds, UK 6 Department of Surgery, University Hospital Erlangen, Erlangen, Germany 7 University of Portsmouth, Portsmouth, UK