Laparoscopic Versus Open Complete Mesocolon Excision in Right Colon Cancer: A Systematic Review and Meta-Analysis
Laparoscopic complete mesocolon excision (LCME) for right colonic cancer improves oncological outcomes. This systematic review and meta-analysis aimed to compare intraoperative, postoperative, and oncological outcomes after LCME and open total mesocolon excision (OCME) for right-sided colonic cancers.
Literature searches of electronic databases and manual searches up to January 31, 2019, were performed. Random-effects meta-analysis model was used. Review Manager Version 5.3 was used for pooled estimates.
After screening 1334 articles, 10 articles with a total of 2778 patients were eligible for inclusion. Compared to OCME, LCME improves results in terms of overall morbidity (OR = 1.48, 95% CI 1.21 to 1.80, p = 0.0001), blood loss (MD = 56.56, 95% CI 19.05 to 94.06, p = 0.003), hospital stay (MD = 2.18 day, 95% CI 0.54 to 3.83, p = 0.009), and local (OR = 2.12, 95% CI 1.09 to 4.12, p = 0.03) and distant recurrence (OR = 1.63, 95% CI 1.23–2.16, p = 0.0008). There was no significant difference regarding mortality, anastomosis leakage, number of harvested lymph nodes, and 3-year disease-free survival. Open approach was significantly better than laparoscopy in terms of operative time (MD = − 34.76 min, 95% CI − 46.01 to − 23.50, p < 0.00001) and chyle leakage (OR = 0.41, 95% CI 0.18 to 0.96, p = 0.04).
This meta-analysis suggests that LCME in right colon cancer surgery is superior to OCME in terms of overall morbidity, blood loss, hospital stay, and local and distant recurrence with a moderate grade of recommendation due to the retrospective nature of the included studies.
Laparoscopic complete mesocolon excision
Open complete mesocolon excision
Complete mesocolon excision
Randomized clinical trials
Controlled clinical trials
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Storli KE, Søndenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I et al (2014) Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol 18(6):557–564PubMedGoogle Scholar
- 6.Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F et al (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan clinical oncology group study JCOG 0404. Annal Surg 260(1):23–30Google Scholar
- 7.Inomata M, Katayama H, Mizusawa J, Watanabe M, Sugihara K, Konishi F, et al. (2015) A randomized controlled trial to evaluate laparoscopic versus open complete mesocolic excision (CME) for stage II, III colorectal cancer (CRC): first efficacy results from Japan clinical oncology group study JCOG0404. Am Soc Clin Oncol 33:656Google Scholar
- 14.Bufill JA (1990) Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Annal Int Med 113(10):779–788Google Scholar
- 15.Meguid RA, Slidell MB, Wolfgang CL, Chang DC, Ahuja N (2008) Is there a difference in survival between right-versus left-sided colon cancers? Annal Surg Oncol 15(9):2388Google Scholar
- 18.Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS et al (2014) Laparoscopic-Assisted Versus Open Complete Mesocolic Excision and Central Vascular Ligation for Right-Sided Colon Cancer. Annal Surg Oncol 21(7):2288–2294Google Scholar
- 21.Li T. (2018) Safety and short-term efficacy of a laparoscopic complete mesocolic excision for the surgical treatment of right hemicolon cancer. Clin Surg Res Commun (Internet) 2(2). https://www.antpublisher.com/index.php/CSRC/article/view/46. Accessed 26 June 2018 (cited 23 Feb 2019)
- 22.Chen Z, Sheng Q, Ying X, Chen W (2017) Comparison of laparoscopic versus open complete mesocolic excision in elderly patients with right hemicolon cancer: retrospective analysis of one single cancer. Int J Clin Exp Med 10(3):5116–5124Google Scholar
- 24.Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW, et al. (2017) Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short-and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc 32(6):2721–2731PubMedPubMedCentralGoogle Scholar
- 25.Guan GX, Liu X, Jiang WZ, Chen ZF, Lu HS (2010) Short-term efficacy of laparoscopic-assisted right hemicolectomy with D3 lymph node dissection in colon cancer. Zhonghua wei chang wai ke za zhi= Chin J Gastrointest Surg 13(12):917–920Google Scholar
- 27.Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341Google Scholar
- 29.Cea E, Clark C, Piccinni G (2017) Laparoscopic Reproducibility of Complete Mesocolon Excision: A Retrospective Analysis. Emergency Surgery 2:3Google Scholar
- 30.Higgins JP (2008) Cochrane handbook for systematic reviews of interventions version 5.0. 1. The Cochrane Collaboration. http://www.cochranehandbook.org
- 32.Higgins JP (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 [updated March 2011]. The Cochrane Collaboration. www cochrane-handbook orgGoogle Scholar
- 36.Storli KE, Eide GE (2016) Laparoscopic complete mesocolic excision versus open complete mesocolic excision for transverse colon cancer: long-term survival results of a prospective single centre non-randomized study. Digest Surg 33(2):114–120Google Scholar
- 38.Munkedal DLE, West NP, Iversen LH, Hagemann-Madsen R, Quirke P, Laurberg S (2014) Implementation of complete mesocolic excision at a university hospital in Denmark: an audit of consecutive, prospectively collected colon cancer specimens. Eur J Surg Oncol (EJSO) 40(11):1494–1501Google Scholar
- 39.Storli KE, Søndenaa K, Furnes B, Eide GE (2013) Outcome after introduction of complete mesocolic excision for colon cancer is similar for open and laparoscopic surgical treatments. Digest Surg 30(4–6):317–327Google Scholar
- 40.Sun YW, Chi P, Lin HM, Lu XR, Huang Y, Xu ZB et al (2012) Comparison of efficacy between laparoscopic versus open complete mesocolic excision for colon cancer. Zhonghua wei chang wai ke za zhi= Chin J Gastrointest Surg 15(1):24–27Google Scholar
- 50.Siani LM, Garulli G (2017) The importance of the mesofascial interface in complete mesocolic excision. Surg 15(4):240–249Google Scholar
- 51.Zhu D-J, Chen X-W, OuYang M-Z, Lu Y (2015) Three surgical planes identified in laparoscopic complete mesocolic excision for right-sided colon cancer. World J Surg Oncol 14(1):7Google Scholar
- 53.Feng H, Zhao X, Zhang Z, Han D, Mao Z, Lu A-G et al (2016) Laparoscopic complete mesocolic excision for stage II/III left-sided colon cancers: a prospective study and comparison with D3 lymph node dissection. J Laparoendosc Adv Surg Tech 26(8):606–613Google Scholar
- 55.Zheng M, Ma J, Fingerhut A, Adamina MP, Atroschenko A, Bergamaschi R, et al. (2018) Complete mesocolic excision for colonic cancer: society for translational medicine expert consensus statement. Ann Laparosc Endosc Surg 3(8)Google Scholar
- 58.Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg Incorporat Eur J Surg Swiss Surg 93(8):921–928Google Scholar
- 59.Cameron C, Fireman B, Hutton B, Clifford T, Coyle D, Wells G et al (2015) Network meta-analysis incorporating randomized controlled trials and non-randomized comparative cohort studies for assessing the safety and effectiveness of medical treatments: challenges and opportunities. Syst Rev 4(1):147PubMedPubMedCentralGoogle Scholar
- 60.Pm 2015 at 2:45. Oxford centre for evidence-based medicine-levels of evidence (March 2009) (Internet). CEBM. 2009. https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009 (cited 2019 Feb 3)