Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2017; 9(12): 475-491
Published online Dec 15, 2017. doi: 10.4251/wjgo.v9.i12.475
Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis
Ionut Negoi, Sorin Hostiuc, Ruxandra Irina Negoi, Mircea Beuran
Ionut Negoi, Department of General Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
Sorin Hostiuc, National Institute of Legal Medicine Mina Minovici, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
Ruxandra Irina Negoi, Department of Anatomy, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
Mircea Beuran, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest 014461, Romania
Author contributions: Negoi I and Negoi RI acquisition of data; Negoi I analysis of data; Negoi I and Hostiuc S interpretation of data; Negoi I drafting the article; Hostiuc S and Negoi RI revising the article; Negoi I, Hostiuc S, Negoi RI and Beuran M final approval; Beuran M conception and design of the study, critical revision; all authors had equally contributed to this scientific paper.
Conflict-of-interest statement: The authors have no conflicts to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ionut Negoi, MD, PhD, Senior Lecturer, Department of General Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy Bucharest, No 8 Floreasca Street, Sector 1, Bucharest 014461, Romania. negoiionut@gmail.com
Telephone: +40-21-5992308 Fax: +40-21-5992257
Received: May 29, 2017
Peer-review started: June 5, 2017
First decision: July 3, 2017
Revised: July 8, 2017
Accepted: September 4, 2017
Article in press: September 4, 2017
Published online: December 15, 2017
Abstract
AIM

To compare the effectiveness of laparoscopic complete mesocolic excision (CME) with central vascular ligation (L-CME) with its open (O-CME) counterpart.

METHODS

We conducted an electronic search of the PubMed/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, SciELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen (lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individual studies.

RESULTS

A total of one RCT and eleven CCTs (four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes (MD = -1.06, 95%CI: -3.65 to 1.53, P = 0.42), and tumor to high tie distance (MD = 14.26 cm, 95%CI: -4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group (MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions (OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall (OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I2 = 28%) and disease-free (OR = 1.45, 95% CI: 1.00 to 2.10, P = 0.05, I2 = 0%) survival.

CONCLUSION

The laparoscopic approach offers the same quality of the resected specimen as the open approach in complete mesocolic excision with central vascular ligation for colon cancer. The laparoscopic complete mesocolic excision with central vascular ligation is superior in all perioperative results and at least non-inferior in long-term oncological outcomes.

Keywords: Colon cancer, Complete mesocolic excision, D3 lymphadenectomy, Central vascular ligation

Core tip: The laparoscopic complete mesocolic excision with central vascular ligation was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes, and tumor to high tie distance; the surface of the resected mesocolon was higher in the laparoscopic group. Laparoscopy was associated with a lower rate of blood transfusions, faster recovery of gastrointestinal function, and less postoperative overall complication rate. The laparoscopic approach was associated with a statistical significant better three-year overall and disease-free survival.