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

Abstract

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.

The Efficacy of Complete Mesocolic Excision with Central Vessel Ligation Technique on Lymph Nodes and Safety Margins Compared with Conventional Surgery for Colon Cancer Treatment: Prospective Observational Study

“…It did result in a substantial rise in the lymph nodes collected number, which in turn decreased the LNR, it is strongly connected to DFS (17) . Our findings concur with those of research that shows that right hemicolectomy with CME produces more lymph nodes than conventional surgery in terms of oncologic results (MD 7.05, 95 percent CI 4.06-10.04) (18) . As was already mentioned, adhering to the recommendations of a combined CME and CVL will impacts the quantity of lymph nodes gathered, cover a sizable drainage area, like the CVL area, and have central or apical lymph nodes that are skipped in a classic dissection, potentially under-staging the cancer from phase III to phase II, such skipped micro metastases may result in a future local recurrence.…”

Novel nomogram for predicting risk of early postoperative small bowel obstruction after right colectomy for cancer

“…According to the latest study, we believe that CME has not proved inferior to traditional surgery in terms of feasibility and safety. And with the expansion of future research samples, this conclusion will be evaluated more accurately [ 34 ]. The current study constructed a novel nomogram based on the findings of multivariate logistic regression analysis, including male sex, open surgery, operative time, and anastomotic leakage.…”

Assessment of adjuvant chemotherapy benefits after complete mesocolic excision in patients with colon cancer: Reanalysis of data from the ESCME trial

“…The technique of colon cancer surgery has been completed and standardized since Hohenberger et al [8] proposed complete mesocolic excision (CME) by combining lymphatic drainage with mesocolic plane dissection, in which the embryological mesocolon, from the viscera to the parietal planes, is removed horizontally and the main artery pedicle is ligated at the root in the vertical direction. Recent studies showed that CME could eliminate tumour tissue by removing the entire relevant mesentery, thereby reducing local recurrence and improving survival significantly [9–13]. However, most studies regarding AC were performed at a time when CME was not proposed and generalized [14].…”

“…drainage with mesocolic plane dissection, in which the embryological mesocolon, from the viscera to the parietal planes, is removed horizontally and the main artery pedicle is ligated at the root in the vertical direction. Recent studies showed that CME could eliminate tumour tissue by removing the entire relevant mesentery, thereby reducing local recurrence and improving survival significantly [9][10][11][12][13].…”