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

Abstract

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.

Multidimensional evaluation of the learning curve for laparoscopic complete mesocolic excision for right colon cancer: a risk‐adjusted cumulative summation analysis

“…Additionally, some authors have claimed that CME is burdened with higher morbidity, in relation to the complex and heterogeneous vascular anatomy of the right colon, the risk of injury to the gastrocolic trunk and the potential avulsion of the middle colic vein due to excessive traction [20,21]. The latest evidence suggests otherwise, namely that CME for RCC is safe and feasible, even with a laparoscopic approach [11,22], ensuring an oncological benefit, as demonstrated by a recent meta-analysis [23].…”

Transmesocolic approach in laparoscopic complete mesocolic excision for right sided colon cancers.

“…Due to the rapid development of CME and laparoscopic surgery, the 5-year overall survival rate for right colon cancer has increased from 82.1% to 89.1% [1]. Since Hohenberger's pioneer study for CME, many studies have suggested and indicated the benefits of CME compared to non-CME resections for right sided colon cancer [19][20][21]. With a lateral approach, embryological fusion of the transverse colon to the adjacent organs can be completely reversed without damaging the mesocolon before separation of the vessels of the central colon.…”

2D vs 3D laparoscopic right colectomy: A propensity score-matching comparison of personal experience with systematic review and meta-analysis

“…Therefore, complete mesocolic excision and central vessel ligation in Western countries, similar to D3 Lymphadenectomy in Asia, have been suggested for right colon cancer. However, to date, the improving in oncological outcome of CME compared to standard surgery has not been definitively stated yet[ 63 - 66 ]. Although no international surgical society has ever recommended right colectomy with CME as “gold standard”, we decided to perform such procedure in as many cases as possible thinking that the conventional right colectomy could not always correctly stage the tumour as it has also been demonstrated recently by Nesgaar et al[ 67 ].…”