Safety, quality and effect of complete mesocolic excision vs non‐complete mesocolic excision in patients with colon cancer: a systemic review and meta‐analysis

• Published in: Colorectal disease Vol. 19; no. 11; pp. 962 - 972
• Main Authors: Wang, C., Gao, Z., Shen, K., Shen, Z., Jiang, K., Liang, B., Yin, M., Yang, X., Wang, S., Ye, Y.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2017
• Subjects: Adult; Aged; Blood; Colectomy - adverse effects; Colectomy - methods; Colon cancer; Colonic Neoplasms - surgery; Colorectal cancer; complete mesocolic excision; Complications; Disease-Free Survival; Female; Humans; Intestine; Lymph Node Excision - statistics & numerical data; Lymph nodes; Lymph Nodes - surgery; Lymphatic system; Male; Mesentery; Mesocolon - surgery; Meta-analysis; Middle Aged; Operative Time; Outcome Assessment (Health Care); Postoperative Complications - etiology; Postoperative Complications - mortality; Safety; Survival; Tumors; complete mesocolic excision; meta-analysis; Colon cancer
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13900

Aim The application of complete mesocolic excision (CME) in colon cancer is controversial. We performed a meta‐analysis to compare the safety, quality and effect of CME with non‐complete mesocolic excision (NCME) in patients with colon cancer. Method We searched PubMed, ScienceDirect, the Cochrane Library and Scopus to identify studies comparing CME with NCME in colon cancer. We focused on three study outcome areas: safety (operation time, blood loss, complications, mortality); quality (large bowel length, distance from the tumour to the high vascular tie, area of mesentery, total lymph nodes); and effect (long‐term survival). Results A total of 8586 patients from 12 studies were included in the meta‐analysis. CME was associated with greater intra‐operative blood loss [weighted mean difference (WMD) 79.87, 95% CI: 65.88–93.86], more postoperative surgical complications (relative risk 1.23, 95% CI: 1.08–1.40), longer large bowel resection (WMD 47.06, 95% CI: 10.49–83.62), greater distance from the tumour to the high vascular tie (WMD 17.51, 95% CI: 15.16–19.87), larger area of mesentery (WMD 36.09, 95% CI: 18.06–54.13) and more lymph nodes (WMD 6.13, 95% CI: 1.97–10.28) than NCME. CME also had positive effects on 5‐year survival [hazard ratio (HR) 0.33, 95% CI: 0.13–0.81], 3‐year survival (HR 0.58, 95% CI: 0.39–0.86) and 3‐year survival for Stage III disease (HR 0.69, 95% CI: 0.60–0.80) compared with NCME. Conclusion Limited evidence suggests that CME is a more effective strategy for improving specimen quality and survival but with a higher complication rate.