Vol.:(0123456789) 1 3 Surgical Endoscopy https://doi.org/10.1007/s00464-019-06869-w DYNAMIC MANUSCRIPT The fusion fascia of Fredet: an important embryological landmark for complete mesocolic excision and D3‑lymphadenectomy in right colon cancer Alvaro Garcia‑Granero 1,2  · Gianluca Pellino 1,3  · Matteo Frasson 1  · Delfna Fletcher‑Sanfeliu 4  · Fernando Bonilla 1  · Luis Sánchez‑Guillén 1  · Alberto Domenech Dolz 1  · Vicent Primo Romaguera 1  · Luis Sabater Ortí 5  · Francisco Martinez‑Soriano 2  · Eduardo Garcia‑Granero 1  · Alfonso A. Valverde‑Navarro 2 Received: 13 January 2019 / Accepted: 18 May 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background The fusion fascia of Toldt is a well-known landmark used by colorectal surgeons. On the contrary, the fusion fascia of Fredet (the plane between the ascending mesocolon and the visceral duodenal-pancreatic peritoneum) still remains a neglected embryological structure. Aim of this study was to provide an anatomic description of this fascia and its applica- tion to minimally invasive D3-lymphadenectomy (D3-L) and complete mesocolic excision (CME) for right colon cancer. Methods First phase: Cadaveric dissection and anatomic description of the fascia of Fredet. Second phase: prospective evaluation of its surgical application in a consecutive series of laparoscopic right hemicolectomies with CME and D3-L at a tertiary hospital. Results The fascia of Fredet was identifed and dissected in one fresh and two formalin-fxed cadavers. The trunk of Henle and the medial border of the superior mesenteric vein defned the medial limit of this embryologic plane. Seventeen patients were operated on. Laparoscopic dissection of the fascia of Fredet was possible in every patient. Median operative time was 210 (120–380) min. There were no major postoperative complications. All cases were adenocarcinomas, except one adeno- matous polyp. T stage was Tis in three, T2 in two, T3 in seven, and T4 in fve patients. Median number of harvested lymph nodes was 24 (9–39). Lymphatic invasion was found in six patients. All resections were classifed as satisfactory mesocolic excision and R0. Median postoperative length of stay was 6 (4–20) days. Median follow-up time was 28 (16–41) months. Local and distal recurrence rate was 0. Conclusion The fusion fascia of Fredet is useful to achieve CME and D3-L in right colon cancers with reduced risk of intraoperative complications. This structure is particularly suitable for minimally invasive surgery; therefore, we encourage awareness of the fascia of Fredet by colorectal surgeons. Keywords Laparoscopy · Colorectal surgery · Fascia · Surgical anatomy · Fredet · Training Complete mesocolic excision (CME) and D3-lymphadenec- tomy (D3-L) are two concepts which involve diferent steps, namely respecting the embryological planes during surgical dissection, high ligation of the vessels feeding the tumour, and Other Interventional Techniques Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-019-06869-w) contains supplementary material, which is available to authorized users. * Gianluca Pellino gipe1984@gmail.com 1 Colorectal Surgery Unit, Hospital Universitario y Politécnico “La Fe”, Av.da Abril Martorell 106, piso 5, torre G, 46023 Valencia, Spain 2 Department of Human Embryology and Anatomy Department, University of Valencia, Valencia, Spain 3 Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy 4 Cardiovascular Surgery, Hospital Universitario Son Espases, Mallorca, Spain 5 Hepatobiliopancreatic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain