Objective:

To delineate current standards in colon cancer resection regarding longitudinal margins, lymphadenectomy, and mesenteric excision.

Approach:

Key Findings:

• Optimal longitudinal margins for most tumors are 5–7 cm, extending to 10 cm for advanced T stage (cT3–cT4) or specific arterial geometry.
• Lymph node assessment beyond the historical minimum of 12 nodes improves staging accuracy and survival, with a plateau around 18–22 examined nodes.
• Complete mesocolic excision (CME) with central vascular ligation (CVL) increases nodal yield and specimen quality without excess morbidity and shows oncologic advantage particularly in stage III disease.

Interpretation:

An oncologically adequate colectomy should aim for R0 resection with appropriate margins, mesenteric resection to the feeding-vessel origin, and systematic lymph node assessment.

Limitations:

• Heterogeneity in international standards and practices regarding colon cancer resection.
• Variability in definitions and classifications of pericolic lymph nodes across different guidelines.

Conclusion:

An adequate colectomy should target specific margins, lymph node yields, and incorporate CME/CVL/D3 techniques, particularly for stage III right colon cancers.

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