Complete Mesocolic Excision Versus Standard Laparoscopic Colectomy in Right-Sided Colon Cancer: Analysis of Short-Term Results from a Single Italian Center

Pedrazzani, Corrado; Lazzarini, Enrico; Turri, Giulia; Conti, Cristian; Secci, Federica; Tripepi, Marzia; Rivelli, Matteo; Valdegamberi, Alessandro; Guglielmi, Alfredo

doi:10.1016/j.ejso.2019.11.231

Cited by 2 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four studies [ 36 , 43 , 48 , 50 ] reported this outcome (591 patients). The incidence of reoperation rate was no different in the two groups, as the difference was not statistically significant (RR 0.65, 95% CI 0.26–1.75).…”

Section: Resultsmentioning

confidence: 89%

“…Eighteen non-randomised controlled trials were included in the qualitative analysis, and 1 study [33] was subsequently excluded from quantitative synthesis, because the reported data were not adequate. Therefore, 17 were included in the meta-analysis (Table 2) [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50].…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [ 43 , 44 , 48 ] reported this outcome (participants = 365). The incidence of intraoperative complications was the same in the CME group (10.67%, 19/178) and in the non-CME group (7.48%, 14/187), as the difference was not statistically significant (RR 1.14, 95% CI 0.60–2.15).…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies [36,37,39,40,42,43,46,[48][49][50] reported this outcome (1307 patients). The incidence of overall postoperative complications was found to be the same in the CME group (17.94%, 141/786) and in the non-CME group (21.16%, 142/617), since the difference was not statistically significant (RR 0.82, 95% CI 0.67-1.00 I 2 = 0%).…”

Section: Overall Postoperative Complicationsmentioning

confidence: 89%

“…Seventeen studies [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] analyses. The heterogeneity was significantly high (I 2 = 98%) and may be due to subgroup effects.…”

Section: Overall Number Of Harvested Lymph Nodesmentioning

confidence: 99%

See 4 more Smart Citations

Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

Background The introduction of complete mesocolic excision (CME) for right colon cancer has raised an important discussion in relation to the extent of colic and mesenteric resection, and the impact this may have on lymph node yield. As uncertainty remains regarding the usefulness of and indications for right hemicolectomy with CME and the benefits of CME compared with a traditional approach, the purpose of this meta-analysis is to compare the two procedures in terms of safety, lymph node yield and oncological outcome. Methods We performed a systematic review of the literature from 2009 up to March 15th, 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two hundred eighty-one publications were evaluated, and 17 met the inclusion criteria and were included. Primary endpoints analysed were anastomotic leak rate, blood loss, number of harvested lymph nodes, 3- and 5-year oncologic outcomes. Secondary outcomes were operating time, conversion, intraoperative complications, reoperation rate, overall and Clavien–Dindo grade 3–4 postoperative complications. Results In terms of safety, right hemicolectomy with CME is not inferior to the standard procedure when comparing rates of anastomotic leak (RR 0.82, 95% CI 0.38–1.79), blood loss (MD −32.48, 95% CI −98.54 to −33.58), overall postoperative complications (RR 0.82, 95% CI 0.67–1.00), Clavien–Dindo grade III–IV postoperative complications (RR 1.36, 95% CI 0.82–2.28) and reoperation rate (RR 0.65, 95% CI 0.26–1.75). Traditional surgery is associated with a shorter operating time (MD 16.43, 95% CI 4.27–28.60) and lower conversion from laparoscopic to open approach (RR 1.72, 95% CI 1.00–2.96). In terms of oncologic outcomes, right hemicolectomy with CME leads to a higher lymph node yield than traditional surgery (MD 7.05, 95% CI 4.06–10.04). Results of statistical analysis comparing 3-year overall survival and 5-year disease-free survival were better in the CME group, RR 0.42, 95% CI 0.27–0.66 and RR 0.36, 95% CI 0.17–0.56, respectively. Conclusions Right hemicolectomy with CME is not inferior to traditional surgery in terms of safety and has a greater lymph node yield when compared with traditional surgery. Moreover, right-sided CME is associated with better overall and disease-free survival.

show abstract

Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Overall Postoperative Complicationsmentioning

confidence: 89%

“…Seventeen studies [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] analyses. The heterogeneity was significantly high (I 2 = 98%) and may be due to subgroup effects.…”

Section: Overall Number Of Harvested Lymph Nodesmentioning

confidence: 99%

See 3 more Smart Citations

Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

Laparoscopic Complete Mesocolic Excision Versus Noncomplete Mesocolic Excision: A Systematic Review and Meta-analysis

Dai

Dong

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: Complete mesocolic excision (CME) emphasizes sharp dissection along the mesocolon plane and ligation of the supplying vessels at their origin. Although laparoscopic CME is reported to be feasible and safe, the benefit of laparoscopic CME over noncomplete mesocolic excision (NCME) remains unclear. This meta-analysis aimed to compare the safety, quality, and effect of laparoscopic CME with NCME. Materials and Methods:A systematic literature search with no limits was performed in PubMed, Embase, and Web of Science on March 27, 2020. Studies comparing laparoscopic CME with NCME were enrolled. Outcomes of interests included intraoperative, pathologic, postoperative, and survival outcomes.Results: Seven studies (5 articles and 2 conference abstracts) published between 2015 and 2020 with a total of 1595 patients (742 by CME and 853 by NCME) were enrolled. Compared with NCME, laparoscopic CME was associated with less intraoperative blood loss [P < 0.001, weighted mean difference (WMD) = −12.01, 95% confidence interval (CI): −13.56 to −10.45, I 2 = 44%], more harvested lymph nodes (P < 0.001, WMD = 6.50, 95% CI: 3.57-9.42, I 2 = 89%), longer length of specimens (P = 0.004, WMD = 3.57, 95% CI: 1.12-6.03, I 2 = 93%), longer distance from tumor to high tie (P < 0.001, WMD = 1.36, 95% CI: 0.87-1.85, I 2 = 76%), and longer distance from nearest bowel wall to high tie (P < 0.001, WMD = 1.36, 95% CI: 0.87-1.85, I 2 = 85%). No differences were observed in terms of operative time, postoperative complications, wound infection, ileus, proximal, and distal resection margin or disease-free survival between 2 groups. Conclusions:The currently limited evidences suggest that laparoscopic CME can slightly decrease intraoperative blood loss and improve specimen quality, but its safety and survival benefits need to be further studied. High-quality evidences are needed before laparoscopic CME can be recommended as the standard procedure for colon cancer surgery.

show abstract

Complete Mesocolic Excision Versus Standard Laparoscopic Colectomy in Right-Sided Colon Cancer: Analysis of Short-Term Results from a Single Italian Center

Cited by 2 publications

References 0 publications

Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis

Right hemicolectomy with complete mesocolic excision is safe, leads to an increased lymph node yield and to increased survival: results of a systematic review and meta-analysis

Laparoscopic Complete Mesocolic Excision Versus Noncomplete Mesocolic Excision: A Systematic Review and Meta-analysis

Contact Info

Product

Resources

About