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Complete mesocolic excision versus standard resection for colon cancer: a systematic review and meta-analysis of perioperative safety and an evaluation of the use of a robotic approach

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Abstract

Purpose

Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly because of the technical complexity and perceived risks of the approach. The aim of out study was to evaluate the safety of CME compared to standard resection and to compare robotic versus laparoscopic approaches.

Methods

Two parallel searches were undertaken in MEDLINE, Embase and Web of Science databases 12 December 2021. The first was to evaluate IDEAL stage 3 evidence to compare complication rates as a surrogate marker of perioperative safety between CME and standard resection. The second independent search compared lymph node yield and survival outcomes between minimally invasive approaches.

Results

There were four randomized control trials (n = 1422) comparing CME to standard resection, and three studies comparing laparoscopic (n = 164) to robotic (n = 161) approaches. Compared to standard resection, CME was associated with a reduction in Clavien–Dindo grade 3 or higher complication rates (3.56% vs. 7.24%, p = 0.002), reduced blood loss (113.1 ml vs. 137.6 ml, p < 0.0001) and greater mean lymph node harvest (25.6 vs. 20.9 nodes, p = 0.001). Between the robotic and laparoscopic groups, there were no significant differences in complication rates, blood loss, lymph node yield, 5-year disease-free survival (OR 1.05, p = 0.87) and overall survival (OR 0.83, p = 0.54).

Conclusions

Our study demonstrated improved safety with CME. There was no difference in safety or survival outcomes between robotic and laparoscopic CME. The advantage of a robotic approach may lie in the reduced learning curve and an increased penetration of minimally invasive approach to CME. Further studies are required to explore this.

Prospero ID

CRD42021287065.

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Data availability

Data archiving is not mandated but data will be made available on reasonable request.

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Author notes

  1. J. Xu and H. M. Mohan are co-first authors.

Authors and Affiliations

  1. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia

    J. Xu, H. M. Mohan, J. T. Larach, S. S. Apte, L. C. L. Cohen, W. Jiang, A. G. Heriot & S. K. Warrier

  2. Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia

    J. T. Larach, A. G. Heriot & S. K. Warrier

  3. Department of Colorectal Surgery, University Hospital Limerick, Limerick, Ireland

    C. Fleming

  4. St. Marks, London, UK

    D. Miskovic

  5. Austin Health, Melbourne, VIC, Australia

    H. M. Mohan

  6. Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile

    J. T. Larach

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All listed authors contributed to the conception and design, acquisition of data, analysis and interpretation of data, drafting and revision of article and approval of final version.

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Correspondence to J. Xu.

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Xu, J., Mohan, H.M., Fleming, C. et al. Complete mesocolic excision versus standard resection for colon cancer: a systematic review and meta-analysis of perioperative safety and an evaluation of the use of a robotic approach. Tech Coloproctol 27, 995–1005 (2023). https://doi.org/10.1007/s10151-023-02838-7

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