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Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta‐analysis
Author(s) -
Athanasiou C. D.,
Markides G. A.,
Kotb A.,
Jia X.,
Gonsalves S.,
Miskovic D.
Publication year - 2016
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13385
Subject(s) - medicine , meta analysis , lymphadenectomy , cochrane library , colorectal cancer , randomized controlled trial , surgery , inclusion and exclusion criteria , hazard ratio , subgroup analysis , laparoscopy , ileus , cancer , confidence interval , alternative medicine , pathology
Aim Several studies report improved survival in colon cancer with use of extended lymphadenectomy techniques ( ELT s), such as D3 lymphadenectomy or complete mesocolic excision. The noninferiority of laparoscopic versus open techniques has already been established in D2 resections. The aim of this study was to compare the safety and efficacy of open and laparoscopic approaches for ELT s in colon cancer. Method Major databases, including PubMed, Scopus and the Cochrane library, were searched using defined inclusion and exclusion criteria, and relevant data were extracted. The Cochrane and Newcastle–Ottawa tools were used for critical appraisal and quality assessment. Meta‐analysis with various subgroup analyses were undertaken, and clinical and statistical heterogeneity, along with publication bias, were also assessed. Results One randomized and seven case–control trials were included. All studies were found to be of low methodological quality with some external validity issues. There was no difference in short‐term mortality [ OR = 2.16 (95% CI : 0.73–6.41); P = 0.16], anastomotic leakage, ileus or deep‐sited infection/abscess. There was a trend for longer operative time [weighted mean difference (WMD) = −30.88 (95% CI : −62.38 to 0.61); P = 0.05] and shorter length of hospital stay [WMD = 2.29 (95% CI : −0.39 to 4.98); P = 0.09] with the laparoscopic approach. Laparoscopic right hemicolectomy had a lower wound‐infection rate [ OR = 2.87 (95% CI : 1.38–5.98); P = 0.005] compared with the relevant open group. No statistically significant difference was found in overall survival [hazard ratio ( HR ) = 0.85 (95% CI : 0.69–1.06); P = 0.15], disease‐free survival, local recurrence and distant metastases. Conclusion Based on the current evidence, the laparoscopic technique appears to be at least as safe as the open technique when used in performing ELT s for colonic cancer, with similar morbidity and oncological outcomes.