Techniques in Coloproctology · 6 authors, 4 centres
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A systematic review and meta-analysis of 24 comparative studies evaluated complete mesocolic excision versus standard right hemicolectomy for primary right colon cancer. CME was associated with greater lymph node harvest, improved 5-year overall and disease-free survival, and reduced local recurrence, without increasing perioperative morbidity.
This systematic review followed PRISMA 2020 guidelines and searched Web of Science, PubMed/Medline, and Embase through February 22, 2023. Among 24 included comparative studies, meta-analysis using random-effects models found that CME significantly increased lymph node harvest (MD 9.62; 95% CI 5.83–13.41; p > 0.0001), 5-year overall survival (OR 1.88; 95% CI 1.14–3.09; p = 0.01), and 5-year disease-free survival (OR 2.21; 95% CI 1.51–3.23; p < 0.0001), and decreased local recurrence (OR 0.27; 95% CI 0.09–0.79; p = 0.02). Perioperative morbidity was similar between groups (OR 1.04; 95% CI 0.89–1.22; p = 0.97). Main limitations include the predominance of observational cohort studies with inherent selection bias risk, heterogeneous pathological specimen quality assessment, potential publication bias, and variable reporting of adjuvant therapy use. The authors conclude that results need confirmation from high-quality randomised controlled trials with long-term follow-up.
