Qualitative umbrella review of systematic reviews on complete mesocolic excision for colon cancer

Background: Complete mesocolic excision (CME) of colon cancer with extended lymphadenectomy was suggested to improve radical resection of colon cancer. This comprehensive review aimed to assess the current literature for the outcomes of CME of colon cancer through an appraisal of the findings of published systematic reviews and meta-analyses. Methods: A systematic literature review searching for the studies that assessed the outcome of CME of colon cancer was conducted. Electronic databases were queried from 2009 through November 2020. The main objectives of this review were to illustrate the technical aspects and outcome of CME and to summarize the findings of the published systematic reviews. Results: Thirteen systematic reviews were retrieved. All reviews found CME to provide longer bowel, larger area of mesentery resected, and more lymph nodes (LNs) retrieved than standard colectomy. All systematic reviews except two found similar complication rates between CME and standard colectomy. Four systematic reviews documented the survival benefit of CME in regards to improved overall and disease-free survival. Using the laparoscopic approach for CME did not compromise the oncologic outcomes of the procedures, yet was associated with less intraoperative blood loss, faster recovery, and potential survival benefits. Conclusions: CME is associated with better specimen quality, more LNs clearance, and potential survival benefits compared to standard colectomy. However, the lack of robust data from well-designed multicenter randomized trials may prevent drawing firm conclusions on the oncologic benefits of CME. Further high-quality studies are needed before recommending CME as the standard of care for colon cancer. (c) 2021 Elsevier Masson SAS. All rights reserved.