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Title: Oncological reasons for performing a complete mesocolic excision: a systematic review and meta-analysis.
Austin Authors: Kong, Joseph C;Prabhakaran, Swetha;Choy, Kay T ;Larach, José T;Heriot, Alexander;Warrier, Satish K
Affiliation: Department of Colorectal Surgery, Alfred Hospital, Melbourne, Victoria, Australia
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile
Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
Issue Date: 5-Jan-2021 2021-01-05
Publication information: ANZ Journal of Surgery 2021; 91(1-2): 124-131
Abstract: While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be weighed up against the risk of major intra-abdominal complications. This paper aimed to assess the comparative oncological benefits of CME. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature until May 2020 was performed. Comparative studies assessing CME versus conventional colonic surgery for colon cancer were compared, and outcomes were pooled. A total of 700 publications were identified, of which 19 were found to meet the inclusion criteria. A total of 25 886 patients were compared, with 14 431 patients in the CME arm. CME was associated with a significantly higher rate of vascular injury (odds ratio 3, P < 0.001). Rates of local and distant recurrence were lower in the CME group (odds ratio 0.66 and 0.73, respectively, both P < 0.001). CME patients had a significantly higher lymph node yield (P < 0.001). While no significant differences were noted between the two groups in terms of pooled 3- or 5-year disease-free survival, pooled 5-year overall survival was significantly higher in the CME group (relative risk 0.82, P < 0.001). Based on the available evidence, CME is associated with improved oncologic outcomes at the expense of higher complication rates, including vascular injury. The oncological benefits need to weighed up against a multitude of factors including the level of hospital support, surgeon experience, patient age, and associated comorbidities.
DOI: 10.1111/ans.16518
ORCID: 0000-0002-1392-2480
Journal: ANZ Journal of Surgery
PubMed URL: 33400369
Type: Journal Article
Subjects: D3 resection
colorectal cancer
complete mesocolic excision
complete mesocolic rection
Appears in Collections:Journal articles

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