Work

Complete Mesocolic Excision Versus Conventional D2 Lymphadenectomy in Right Hemicolectomy: a Meta-analysis of Propensity Score Matched Studies and Randomized Controlled Trials

Year: 2024

Type: review

Study designs: Systematic Review, Meta-Analysis

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. Objective Our meta-analysis aims to demonstrate the outcomes of CME versus D2 conventional lymphadenectomy for right-sided colon cancer. Methods We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE 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 I² statistics, with p-values < 0.10 and I²> 25% considered significant. Statistical analysis was performed using R Software, version 4.1.2. Results Three randomized controlled trials and four observational studies comprising 2,296 patients were included, of whom 1,138 (49.6%) were submitted to the CME and 1,158 (50.4%) to the conventional D2 lymphadenectomy. CME was associated with decreased local recurrence rates (OR 0.07; 95% CI 0.01 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 decreased local recurrence rates and increased the number of harvested lymph nodes compared with D2 lymphadenectomy in patients with right-side colon cancer. No difference was observed between groups in rates of overall complications, severe complications, intraoperative complications, blood loss, and 30-day mortality. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Source: Journal of Coloproctology

DOI: 10.1055/s-0045-1808853