Complete mesocolic excision versus D2 lymphadenectomy in right hemicolectomy: a meta-analysis of propensity score matched studies and randomized controlled trials.

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2025-02-11 eCollection Date: 2025-02-01 DOI:10.1097/MS9.0000000000002829
Bernardo Fontel Pompeu, Eric Pasqualotto, Patrícia Marcolin, Lucas Monteiro Delgado, Beatriz D'Andrea Pigossi, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga
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引用次数: 0

Abstract

Introduction: The complete mesocolic excision (CME) in right-sided hemicolectomy could result in higher lymph node yield and decreased local recurrence. However, this approach could increase intraoperative and postoperative complications. Therefore, our meta-analysis aims to demonstrate the outcomes of CME versus D2 conventional lymphadenectomy in right-side colon cancer.

Methods: We searched MEDLINE, Cochrane Central Register of Clinical Trials, and Scopus for studies published until April 2024. Odds ratios (OR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I 2 statistics, with P values <0.10 and I 2 >25% considered significant. Statistical analysis was performed using R Software, version 4.1.2.

Results: Three randomized controlled trials and four observational studies comprising 2296 patients were included, of whom 1138 (49.6%) were submitted to the CME and 1158 (50.4%) to the conventional D2 lymphadenectomy. CME was associated with decreased local recurrence rates (OR 0.07; 95% CI 0.001 to 0.36; P = 0.002). There were no significant differences between groups in overall complications, severe complications, intraoperative complications, blood loss, and 30-day mortality. No difference between groups was observed in distance metastasis and 3-year disease-free survival.

Conclusion: In this meta-analysis, CME significantly decreases local recurrence rates compared with D2 conventional lymphadenectomy in patients with right-side colon cancer. No significant difference was observed between groups in rates of overall complications, severe complications, intraoperative complications, blood loss, and 30-day mortality.

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Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
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