Complete Mesocolic Excision in Colon Cancer: A Systematic Review and Meta Analysis

Darren J Porter* , Diana Yung and Mark A Potter

Departments of Colorectal Surgery, Ninewells Hospital, Dundee and Western General Hospital, Edinburgh, Scotland, UK

^*Correspondance to: Darren J Porter 

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Abstract:

Objectives: To compare the outcomes of patients undergoing open and laparoscopic right hemicolectomy with complete mesocolic excision to outcomes following standard open and laparoscopic right hemicolectomy. Introduction: The surgical treatment of colorectal cancer stands at a crossroads with alternative strategies for lymphadenectomy currently being evaluated. Right hemicolectomy and complete mesocolic excision is an alternative to standard right hemicolectomy. Design, methods and data sources: The preferred reporting items for systematic reviews and meta analyses guidelines were followed in undertaking this study. Medline was searched to identify all studies describing open and laparoscopic right hemicolectomy with complete mesocolic excision from 2008 to 2018. Statistical analysis was performed using the ‘Meta’ and ‘Metafor’ packages in R statistical software. Study selection: Systematic review and meta analysis. Patients: A total of 1,048 adult male and female patients with age ranges from 35 to 96 years were evaluated during this study. Primary and secondary outcome measures: This study aims to evaluate open and laparoscopic right hemicolectomy with complete mesocolic excision and compare 30 day morbidity and mortality, duration of surgery, intra operative blood loss, lymph node harvest, disease free survival, local recurrence and rates of anastomotic leaks to similar outcomes following standard open and laparoscopic right hemicolectomy to determine whether this technique should be the recommended nodal harvesting strategy during right hemicolectomy. Setting: Not applicable Results: 14 studies with a total of 1,048 patients were included in this review. Complete mesocolic excision offered reduced local recurrence (2% vs. 14%) and improved disease free survival (95% vs. 75.8%), however duration of surgery and post operative stay were increased (130 to 288 vs. 130 min) and (8 days vs. 5 days) respectively. Conclusion: Complete mesocolic excision might upstage and could improve prognosis in colorectal cancer, however this procedure could increase patient morbidity and mortality. Further research is necessary to definitively evaluate this technique.

Keywords:

Colon cancer; Right hemicolectomy; D2 lymphadenectomy; Complete mesocolic excision; CME; Hohenberger

Cite the Article:

Porter DJ, Yung D, Potter MA. Complete Mesocolic Excision in Colon Cancer: A Systematic Review and Meta Analysis. World J Surg Surgical Res. 2019; 2: 1149..