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Oncological reasons for performing a complete mesocolic excision: a systematic review and meta‐analysis
Author(s) -
Kong Joseph C.,
Prabhakaran Swetha,
Choy Kay T.,
Larach José T.,
Heriot Alexander,
Warrier Satish K.
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.16518
Subject(s) - medicine , meta analysis , odds ratio , colorectal cancer , relative risk , confidence interval , systematic review , surgery , medline , cancer , political science , law
Abstract Background While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be weighed up against the risk of major intra‐abdominal complications. This paper aimed to assess the comparative oncological benefits of CME. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines, a systematic review of the literature until May 2020 was performed. Comparative studies assessing CME versus conventional colonic surgery for colon cancer were compared, and outcomes were pooled. Results A total of 700 publications were identified, of which 19 were found to meet the inclusion criteria. A total of 25 886 patients were compared, with 14 431 patients in the CME arm. CME was associated with a significantly higher rate of vascular injury (odds ratio 3, P < 0.001). Rates of local and distant recurrence were lower in the CME group (odds ratio 0.66 and 0.73, respectively, both P < 0.001). CME patients had a significantly higher lymph node yield ( P < 0.001). While no significant differences were noted between the two groups in terms of pooled 3‐ or 5‐year disease‐free survival, pooled 5‐year overall survival was significantly higher in the CME group (relative risk 0.82, P < 0.001). Conclusion Based on the available evidence, CME is associated with improved oncologic outcomes at the expense of higher complication rates, including vascular injury. The oncological benefits need to weighed up against a multitude of factors including the level of hospital support, surgeon experience, patient age, and associated comorbidities.