Complete mesocolic excision versus D2 Lymphadenectomy in right hemicolectomy: a meta-analysis of propensity score matched studies and randomized controlled trials
Bernardo Fontel Pompeu, Eric Pasqualotto, Patrícia Marcolin, Lucas Monteiro Delgado, Beatriz D’ANDREA Pigossi, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti FormigaIntroduction:
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 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 0.001 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.