TY - JOUR
T1 - Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis
AU - De Simoni, Ottavia
AU - Barina, Andrea
AU - Sommariva, Antonio
AU - Tonello, Marco
AU - Gruppo, Mario
AU - Mattara, Genny
AU - Toniato, Antonio
AU - Pilati, Pierluigi
AU - Franzato, Boris
N1 - Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11/10
Y1 - 2020/11/10
N2 - Purpose: Complete mesocolic excision (CME) has introduced a promising surgical approach for treatment of right colon cancer. However, benefits of CME are still a matter of debate. We conducted a systematic review and meta-analysis to assess safety and long-term outcomes of CME versus conventional right hemicolectomy (CRH). Methods: We systematically searched MEDLINE, the Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase for retrieving studies comparing CME with CRH in right colon cancer. After data extraction from the included studies, meta-analysis was performed to compare postoperative complications, anastomotic leakage, 30-day mortality, number of lymph node yield, disease-free survival (DFS), and overall survival (OS). Results: Eight studies met the inclusion criteria with a total of 1871 patients enrolled. No difference was observed in postoperative complications (OR 1.13, 95% CI 0.88–1.47, p = 0.34). CME was associated with significantly higher number of lymph nodes retrieved (MD 9.17, CI 4.67–13.68, p < 0.001). CME also improved 3-year OS (OR 1.57, 95% CI 1.17–2.11, p = 0.003), 5-year OS (OR 1.41, 95% CI 1.06–1.89, p = 0.02), and 5-year DFS (OR 1.99, 95% CI 1.29–3.07, p = 0.002). A sub-group analysis for patients with stage III colon cancer showed no significant impact of CME on 3-year and 5-year OS (OR 2.47, 95% CI 0.86–7.06, p = 0.09; OR 1.23, 95% CI 0.78–1.94, p = 0.38). Conclusion: Although with limited evidence, CME shows similar postoperative complication rates and an improved survival outcome compared with CRH.
AB - Purpose: Complete mesocolic excision (CME) has introduced a promising surgical approach for treatment of right colon cancer. However, benefits of CME are still a matter of debate. We conducted a systematic review and meta-analysis to assess safety and long-term outcomes of CME versus conventional right hemicolectomy (CRH). Methods: We systematically searched MEDLINE, the Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase for retrieving studies comparing CME with CRH in right colon cancer. After data extraction from the included studies, meta-analysis was performed to compare postoperative complications, anastomotic leakage, 30-day mortality, number of lymph node yield, disease-free survival (DFS), and overall survival (OS). Results: Eight studies met the inclusion criteria with a total of 1871 patients enrolled. No difference was observed in postoperative complications (OR 1.13, 95% CI 0.88–1.47, p = 0.34). CME was associated with significantly higher number of lymph nodes retrieved (MD 9.17, CI 4.67–13.68, p < 0.001). CME also improved 3-year OS (OR 1.57, 95% CI 1.17–2.11, p = 0.003), 5-year OS (OR 1.41, 95% CI 1.06–1.89, p = 0.02), and 5-year DFS (OR 1.99, 95% CI 1.29–3.07, p = 0.002). A sub-group analysis for patients with stage III colon cancer showed no significant impact of CME on 3-year and 5-year OS (OR 2.47, 95% CI 0.86–7.06, p = 0.09; OR 1.23, 95% CI 0.78–1.94, p = 0.38). Conclusion: Although with limited evidence, CME shows similar postoperative complication rates and an improved survival outcome compared with CRH.
KW - Complete mesocolic excision
KW - Right colon cancer
KW - Right hemicolectomy
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U2 - 10.1007/s00384-020-03797-3
DO - 10.1007/s00384-020-03797-3
M3 - Review article
AN - SCOPUS:85095763502
SP - 1
EP - 12
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
SN - 0179-1958
ER -