Austin Health

Title
Oncological reasons for performing a complete mesocolic excision: a systematic review and meta-analysis.
Publication Date
2021-01-05
Author(s)
Kong, Joseph C
Prabhakaran, Swetha
Choy, Kay T
Larach, José T
Heriot, Alexander
Warrier, Satish K
Subject
D3 resection
colorectal cancer
complete mesocolic excision
complete mesocolic rection
Type of document
Journal Article
OrcId
0000-0002-1392-2480
0000-0002-3010-5247
0000-0001-5763-5742
0000-0001-9846-8776
DOI
10.1111/ans.16518
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.
Link
Citation
ANZ Journal of Surgery 2021; 91(1-2): 124-131
Jornal Title
ANZ Journal of Surgery

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