Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic versus open complete mesocolic excision: a systematic review by updated meta-analysis

  • Review Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Recent evidence has proven the non-inferiority of laparoscopic complete mesocolic excision (LCME) to open complete mesocolic excision (OCME) with regard to feasibility and oncological safety. However, the differences in survival benefits between the 2 procedures have not been assessed. The aim of this study was to evaluate whether or not one procedure was superior to the other using updated meta-analysis. A systematic search for relevant literature was performed in Pubmed, Embase, Cochrane library and Google scholar databases. This meta-analysis included retrospective studies and one randomised controlled trial comparing LCME to OSCME. LCME to OCME was evaluated using updated meta-analysis. The Newcastle–Ottawa scale was used to assess the methodologic quality of the studies. Fixed- and random-effects models were used, and survival outcomes were assessed using the inverse variance hazard ratio (HR) method. Operative time was significantly shorter in the OCME cohort than in the LCME cohort. Blood loss, wound infections, time to flatus, time to oral feeding, and length of hospital stay were significantly shorter in the LCME cohort than in the OCME cohort. The 1-, 3-, and 5-year overall survivals were better in the LCME cohort than in the OCME cohort ([HR = 0.37 (0.22, 0.65); p = 0.004], [HR = 0.48 (0.31, 0.74); p = 0.008], and [HR = 0.64 (0.45, 0.93); p = 0.02], respectively). No difference in the 1-year disease-free survival (DFS) between the 2 procedures was observed ([HR = 0.68 (0.44, 1.03); p = 0.07]). In contrast, the LCME cohort had better 3- and 5-year DFS rates than those of the OCME cohort ([HR = 0.63 (0.42, 0.97), p = 0.03] and [HR = 0.68 (0.56, 0.83), p = 0.001], respectively). The results of the present study must be interpreted cautiously because the included studies were retrospective from single centres. Therefore, selection, institutional and national bias may have influenced the results. LCME is associated with the faster postoperative recovery and some better potential survival benefits than OCME.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome. Colorectal Dis 11:354–364 (discussion 364-5)

    Article  CAS  PubMed  Google Scholar 

  2. West NP, Kennedy RH, Magro T, Luglio G, Sala S, Jenkins T, Quirke P (2014) Morphometric analysis and lymph node yield in laparoscopic mesocolic excision performed by supervised trainees. Br J Surg 101:1460–1467

    Article  CAS  PubMed  Google Scholar 

  3. 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. Ann Surg 260:23–30

    Article  PubMed  Google Scholar 

  4. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W et al (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769

    Article  PubMed  Google Scholar 

  5. Birindelli A, Segalini E, Kwan S, Biscardi A, Tonini V, Di Saverio S (2017) Challenging emergency laparoscopic right colectomy for completely obstructing caecal carcinoma. Colorectal Dis 19(5):504–506. https://doi.org/10.1111/codi.13645

    Article  CAS  PubMed  Google Scholar 

  6. Di Saverio S, Birindelli A, Segalini E, Novello M, Larocca A, Ferrara F, Binda GA, Bassi M (2018) To stent or not to stent?: immediate emergency surgery with laparoscopic radical colectomy with CME and primary anastomosis is feasible for obstructing left colon carcinoma. Surg Endosc 32(4):2151–2155. https://doi.org/10.1007/s00464-017-5763-y

    Article  PubMed  Google Scholar 

  7. Athanasiou CD, Markides GA, Kotb A, Jia X, Gonsalves S, Miskovic D (2016) Open compared with laparoscopic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Colorectal Dis 18:224–235

    Article  Google Scholar 

  8. Moher D, Liberati A, Tetzlaff J, Altman DG et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med 6(6):e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. https://www.ohri.ca/programs/clinicalepidemiology/oxford.asp

  10. Higgins JPT, Greens S (eds) (2011)Cochrane handbook for systematic reviews of interventions version 5.1 [update March 2011]. The Cochrane Collaboration 2011. www.cochrane.handbook.org

  11. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hozo SP, Diulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed  PubMed Central  Google Scholar 

  13. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17:2815–2834

    Article  CAS  PubMed  Google Scholar 

  14. Harbord RM, Harris RJ, Sterne JA (2009) Updated tests for small-study effects in meta-analyses. The Stata J 9:197–210

    Article  Google Scholar 

  15. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  16. Gouvas N, Pechlivanides G, Zervakis N, Kafousi M, Xynos E (2012) Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Colorectal Dis 14:1357–1364

    Article  CAS  PubMed  Google Scholar 

  17. Zhao LY, Chi P, Ding WX, Huang SR, Zhang SF, Pan K et al (2014) Laparoscopic vs open extended right hemicolectomy for colon cancer. World J Gastroenterol 20:7926–7932

    Article  PubMed  PubMed Central  Google Scholar 

  18. Han DP, Lu AG, Feng H, Wang PX, Cao QF, Zong YP et al (2014) Long-term outcome of Laparoscopic-assisted right hemicolectomy with D3 lymphadenectomy versus open surgery for colon carcinoma. Surg Today 44:868–874

    Article  PubMed  Google Scholar 

  19. 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. Dig Surg 30:317–327

    Article  PubMed  Google Scholar 

  20. Bae SU, Saklami 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. Ann Surg Oncol 21:2288–2294

    Article  PubMed  Google Scholar 

  21. Munkendal DL, 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 40:1494–1501

    Article  Google Scholar 

  22. Huang JL, Wei HB, Fang JF, Zheng ZH, Chen TF, Wei B et al (2015) Comparison of laparoscopic versus open complete mesocolic excision for right colon cancer. Int J Surg 23:12–17

    Article  PubMed  Google Scholar 

  23. 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. Dig Surg 33:114–120

    Article  PubMed  Google Scholar 

  24. Kim IY, Kim BR, Choi EH, Kim YW (2016) Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation. Int J Surg 27:151–157

    Article  PubMed  Google Scholar 

  25. 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 10:5116–5124

    Google Scholar 

  26. Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW et al (2018) Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and lon-term outcomes compared with the open approach in propensity score analysis. Surg Endosc 32:2721–2731

    Article  PubMed  Google Scholar 

  27. Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB (2012) Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicentre analysis of 4852 cases. Dis Col Rec 55:1300–1310

    Article  Google Scholar 

  28. Gavriilidis P, Katsanos K (2018) Laparoscopic versus open transverse colectomy: a systematic review and meta-analysis. World J Surg 42:3008–3014

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of General and Colorectal Surgery, York Teaching Hospitals, NHS Foundation Trust, Scarborough, YO12 6QL, UK

    Paschalis Gavriilidis

  2. Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals, NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK

    R. Justin Davies, James Wheeler & Salomone Di Saverio

  3. Department of Surgery, University of Catania, Catania, Italy

    Antonio Biondi

  4. Department of Surgery, University of Bari, Bari, Italy

    Mario Testini

  5. Department of Surgery, University of Insubria, Insubria, Italy

    Giulio Carcano

Authors
  1. Paschalis Gavriilidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Justin Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonio Biondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Wheeler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Testini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giulio Carcano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Salomone Di Saverio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salomone Di Saverio.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of article ethical approval does not required because does not contain any studies with human participants or animals performed by any of the authors.

Human and animal rights

This study does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent was not necessary.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gavriilidis, P., Davies, R.J., Biondi, A. et al. Laparoscopic versus open complete mesocolic excision: a systematic review by updated meta-analysis. Updates Surg 72, 639–648 (2020). https://doi.org/10.1007/s13304-020-00819-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00819-1

Keywords

Search

Navigation