Right colon cancer: laparoscopic vs open complete mesocolon excision

  • Chaouch MA & al.
  • World J Surg
  • 22 Aug 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that laparoscopic complete mesocolon excision (LCME) in right colon cancer surgery is superior to open total mesocolon excision (OCME) in terms of overall morbidity, blood loss, hospital stay, operative time, chyle leakage, local and distant recurrence.

Why this matters

  • Findings warrant the need for randomised controlled trials to compare LCME and OCME for right-sided colon cancer.

Study design

  • 10 controlled-clinical trials involving 2778 patients who underwent LCME (n=1407) and OCME (n=1371) met eligibility criteria after a search across electronic databases.
  • Funding: None disclosed.

Key results

  • Compared with OCME, LCME offers better outcomes in terms of:
    • overall morbidity: OR, 1.48; 95% CI, 1.21-1.80; P=.0001;
    • blood loss: mean difference (MD), 56.56; 95% CI, 19.05-94.06; P=.003;
    • hospital stay: MD, 2.18 (95% CI, 0.54-3.83) days; P=.009;
    • local recurrence: OR, 2.12; 95% CI, 1.09-4.12; P=.03 and
    • distant recurrence: OR, 1.63; 95% CI, 1.23-2.16; P=.0008.
  • However, OCME was significantly better than LCME in terms of:
    • operative time: MD, −34.76 (95% CI, −46.01 to −23.50) minutes; P<.00001 and>
    • chyle leakage: OR, 0.41; 95% CI, 0.18-0.96; P=.04.
  • Mortality, anastomosis leakage, number of harvested lymph nodes, and 3-year or 5-year disease-free survival did not differ between the groups.

Limitations

  • Risk of bias.
  • Absence of randomised controlled trials.