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

被引:52
作者
De Simoni, Ottavia [1 ]
Barina, Andrea [1 ]
Sommariva, Antonio [1 ]
Tonello, Marco [1 ]
Gruppo, Mario [1 ]
Mattara, Genny [1 ]
Toniato, Antonio [2 ]
Pilati, Pierluigi [1 ]
Franzato, Boris [1 ]
机构
[1] IRCCS, IOV, Unit Surg Oncol Esophagus & Digest Tract, Surg Oncol Dept,Veneto Inst Oncol, Via Carpani 16, I-31033 Castelfranco Veneto, TV, Italy
[2] IRCSS, IOV, Veneto Inst Oncol, Endocrine Surg Unit, Padua, Italy
关键词
Complete mesocolic excision; Right colon cancer; Right hemicolectomy; CENTRAL VASCULAR LIGATION; ONCOLOGICALLY SUPERIOR; RECTAL-CANCER; SURGERY; RESECTION; SURVIVAL; LYMPHADENECTOMY; OUTCOMES; QUALITY; DISSECTION;
D O I
10.1007/s00384-020-03797-3
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:881 / 892
页数:12
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