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Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis

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Abstract

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.

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Authors and Affiliations

  1. Unit of Surgical Oncology of the Esophagus and Digestive Tract, Surgical Oncology Department, Veneto Institute of Oncology, IOV-IRCCS, Via dei Carpani, 16, 31033, Castelfranco Veneto, TV, Italy

    Ottavia De Simoni, Andrea Barina, Antonio Sommariva, Marco Tonello, Mario Gruppo, Genny Mattara, Pierluigi Pilati & Boris Franzato

  2. Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCSS, Padua, Italy

    Antonio Toniato

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  1. Ottavia De Simoni
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  2. Andrea Barina
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  3. Antonio Sommariva
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  4. Marco Tonello
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Correspondence to Andrea Barina.

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De Simoni, O., Barina, A., Sommariva, A. et al. Complete mesocolic excision versus conventional hemicolectomy in patients with right colon cancer: a systematic review and meta-analysis. Int J Colorectal Dis 36, 881–892 (2021). https://doi.org/10.1007/s00384-020-03797-3

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