A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

Gabriele Anania, Alberto Arezzo, Richard Justin Davies, Francesco Marchetti, Shu Zhang, Salomone Di Saverio, Roberto Cirocchi, Annibale Donini, Gabriele Anania, Alberto Arezzo, Richard Justin Davies, Francesco Marchetti, Shu Zhang, Salomone Di Saverio, Roberto Cirocchi, Annibale Donini

Abstract

Purpose: The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery.

Methods: PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios.

Results: Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, - 0.41-1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI - 0.20-6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD - 0.55, 95% CI - 0.57-1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups.

Conclusions: Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.

Keywords: CME colectomy; Laparoscopic surgery; Open surgery; Right hemicolectomy.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Prisma flow chart of literature search
Fig. 2
Fig. 2
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Overall number of harvested lymph nodes
Fig. 3
Fig. 3
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Operative time
Fig. 4
Fig. 4
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Intraoperative blood loss
Fig. 5
Fig. 5
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Anastomotic leak
Fig. 6
Fig. 6
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Chylous leak

References

    1. Mattiuzzi C, Sanchis-Gomar F, Lippi G. Concise update on colorectal cancer epidemiology. Ann Transl Med. 2019;7:609. doi: 10.21037/atm.2019.07.91.
    1. International Agency for Research on Cancer, Global Cancers Observatory: Fact sheets cancers. Available at . Accessed 24 march 2020
    1. Lu JY, Xu L, Xue HD, Zhou WX, Xu T, Qiu HZ, Wu B, Lin GL, Xiao Y. The radical extent of lymphadenectomy - D2 dissection versus complete mesocolic excision of LAparoscopic right colectomy for right-sided colon cancer (RELARC) trial: study protocol for a randomized controlled trial. Trials. 2016;17:582. doi: 10.1186/s13063-016-1710-9.
    1. O’Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst. 2004;96:1420–1425. doi: 10.1093/jnci/djh275.
    1. American Cancer Society: Treating Colorectal Cancer. Available at . Accessed 24 march 2020
    1. Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst. 2001;93:583–596. doi: 10.1093/jnci/93.8.583.
    1. Vogel JD, Eskicioglu C, Weiser MR, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the treatment of colon cancer. Dis Colon Rectum. 2017;60:999–1017. doi: 10.1097/DCR.0000000000000926.
    1. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Color Dis. 2009;11:354–364. doi: 10.1111/j.1463-1318.2008.01735.x.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–1012. doi: 10.1371/journal.pmed.1000097.
    1. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J. 2011;343:d5928. doi: 10.1136/bmj.d5928.
    1. Higgins JPT, Sterne JAC (2017) Chapter 8: Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions version 520 (updated June 2017)
    1. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73:712–716. doi: 10.1046/j.1445-2197.2003.02748.x.
    1. El Nakeeb AES, Elhawary AAA. . Accessed 24 March 2020
    1. Wang F, Zhang H, Chu H, Zhu K, Zhang L, Meng W, Zhao S, Zhou W, Li X. The clinical outcomes and prognostic analysis of elderly patients with stage III right colon cancer undergo laparoscopic complete mesocolon. Chin J Bases Clin Gen Surg. 2020;27:69–74. doi: 10.7507/1007-9424.201907020.
    1. Elbalshy MA, El Fol HA, Ammar MS, Hagag MG. Outcomes of laparoscopic assisted versus open complete mesocolic excision for right sided colon cancer. Int Surg J. 2019;6:4203–4209. doi: 10.18203/2349-2902.isj20195376.
    1. El-Fol HA, Ammar MS, Abdelaziz TF, Elbalshy MA, Elabassy MM. Laparoscopic versus open complete mesocolic excision with central vascular ligation in right colon cancer. Int Surg J. 2019;6:1566–1573. doi: 10.18203/2349-2902.isj20191871.
    1. Jin D, Chen G. Complete mesocolic excision for right colon cancer: laparoscopic versus open surgery. Zhejiang Med. 2019;41:1312–1315. doi: 10.12056/j.issn.1006-2785.2019.41.12.2019-636.
    1. Pelz JOW, Wagner J, Lichthardt S, Baur J, Kastner C, Matthes N, Germer CT, Wiegering A. Laparoscopic right-sided colon resection for colon cancer-has the control group so far been chosen correctly? World J Surg Oncol. 2018;16:117. doi: 10.1186/s12957-018-1417-3.
    1. Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW, Park YA, Chun HK. Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc. 2018;32:2721–2731. doi: 10.1007/s00464-017-5970-6.
    1. Yu M, Qi Y, Qin S, Mu Y, Luo Y, Qiu Y, Cui R, Zhong M. A retrospective controlled clinical study on laparoscopic versus open complete mesocolic excision for right colon cancer. J Surg Concepts Pract. 2018;23:145–149. doi: 10.16139/j.1007-9610.2018.02.013.
    1. Li T, Meng XL, Chen W. Safety and short-term efficacy of a laparoscopic complete mesocolic excision for the surgical treatment of right hemicolon cancer. Clin Surg Res Commun. 2018;2:29–33. doi: 10.16139/j.1007-9610.2018.02.013.
    1. Aiypov RT, Safiullin RI, Garipov MR, Feoktistov DV, Tarasov NA, Garipova AA, Garipov RR. Initial results of D3 lymphadenectomy in the surgical treatment of cancer of the right half of the segmented intestine. Creat Surg Oncol. 2018;8:142–146. doi: 10.24060/2076-3093-2018-8-2-58-62.
    1. Rasulov AO, Malikhov AG, Rakhimov OA, Kozlov NA, Malikhova OA. Short-term outcomes of complete mesocolic excision for right colon cancer. Khirurgiia (Mosk) 2017;8:79–86. doi: 10.17116/hirurgia2017879-86.
    1. Chen Z, Sheng Q, Ying X, Chen W. Comparison of laparoscopic versus open complete mesocolic excision in elderly patients with right hemicolon cancer: retrospective analysis of one single cancer. Int J Clin Exp Med. 2017;10:5116–5124.
    1. Mondal SK, Roy S, Uddin MS, Murshec M, Bashar A. Complete mesocolic excision for right sided coloninc carcinoma – our experience in tertiary care hospital. J Surg Sci. 2017;21:15–18. doi: 10.3329/jss.v21i1.43833.
    1. Cong J, Chen C, Feng Y, Ma M, Xia Z, Liu D. Comparison of short-term outcomes between laparoscopic and open complete mesocolic excision/D3 radical operation for stage II/III right hemicolon carcinoma. Chin J Clin Oncol. 2014;41:1591–1596.
    1. Huang Y, Liu JP. Comparison of laparoscopic versus open complete mesocolic excision for right colon cancer. Int J Surg (Chin Med Assoc) 2015;23:12–17. doi: 10.1016/j.ijsu.2015.08.037.
    1. Yin F, Weng Z, Cen H, Tang C. The effect of complete mesocolic excision in the operation of right colon cancer under laparoscope. Chin J Laparosc Surg (Electron Ed) 2015;8:187–190. doi: 10.3877/cma.j.issn.1674-6899.2015.03.005.
    1. Liu J. Clinical analysis of laparoscopic versus open complete mesocolic excision for right colon cancer. China J Endosc. 2015;21:475–478.
    1. Gao B, Zhang Y, Zhou C, Wang D, Ma J, Tang D, Jiang P, Yuan J, Wang Y, Yang F. Comparison of laparoscopy-assisted complete mesocolic excision and open operation for right-hemi colon cancer: the safety and short-term outcome. Int J Surg (Chin Med Assoc) 2015;42:532–535. doi: 10.3760/cma.j.issn.1673-4203.2015.08.010.
    1. Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol. 2014;21:2288–2294. doi: 10.1245/s10434-014-3614-9.
    1. Zhao LY, Chi P, Ding WX, Huang SR, Zhang SF, Pan K, Hu YF, Liu H, Li GX. Laparoscopic vs open extended right hemicolectomy for colon cancer. World J Gastroenterol. 2014;20:7926–7932. doi: 10.3748/wjg.v20.i24.7926.
    1. Han DP, Lu AG, Feng H, Wang PXZ, Cao QF, Zong YP, Feng B, Zheng MH. Long-term outcome of laparoscopic-assisted right-hemicolectomy with D3 lymphadenectomy versus open surgery for colon carcinoma. Surg Today. 2014;44:868–874. doi: 10.1007/s00595-013-0697-z.
    1. Zhao G, Chen L. Clinical efficacy of laparoscopic laparoscopic complete mesocolic excision with a medial-to-lateral approach for right colon cancer. Chin J Dig Surg. 2014;13(8):645–647.
    1. Guan GX, Liu X, Jiang WZ, Chen ZF, Lu HS. Short-term efficacy of laparoscopic-assisted right hemicolectomy with D3 lymph node dissection in colon cancer. Chin J Gastrointest Surg. 2010;13:917–920. doi: 10.3760/cma.j.issn.1671-0274.2010.12.012.
    1. Croner R, Hohenberger W, Strey CW. Comparison of open vs. laparoscopic techniques in complete mesocolic excision (CME) during right hemicolectomy. Zentralbl Chir. 2015;140(6):580–582. doi: 10.1055/s-0035-1558104.
    1. Chaouch MA, Dougaz MW, Bouasker I, Jerraya H, Ghariani W, Khalfallah M, Nouira R, Dziri C. Laparoscopic versus open complete mesocolon excision in right colon cancer: a systematic review and meta-analysis. World J Surg. 2019;43:3179–3190. doi: 10.1007/s00268-019-05134-4.
    1. Alhassan N, Yang M, Wong-Chong N, Liberman AS, Charlebois P, Stein B, Fried GM, Lee L. Comparison between conventional colectomy and complete mesocolic excision for colon cancer: a systematic review and pooled analysis: a review of CME versus conventional colectomies. Surg Endosc. 2019;33:8–18. doi: 10.1007/s00464-018-6419-2.
    1. Lucchi A, Berti P, Gabbianelli C, Alagna V, Guerra M, Corbucci Vitolo G, Vandi F, Garulli G. Totally laparoscopic right colectomy with complete mesocolon excision. Eur J Surg Oncol. 2018;44:547–558. doi: 10.1016/j.ejso.2018.01.049.
    1. Negoi I, Hostiuc S, Negoi RI, Beuran M. Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: a systematic review and meta-analysis. World J Gastrointest Oncol. 2017;9:475–491. doi: 10.4251/wjgo.v9.i12.475.
    1. Sheng QS, Pan Z, Chai J, Cheng XB, Liu FL, Wang JH, Chen WB, Lin JJ. Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches. Ann Surg Treat Res. 2017;92:90–96. doi: 10.4174/astr.2017.92.2.90.
    1. Yang X, Wu Q, Jin C, He W, Wang M, Yang T, Wei M, Deng X, Meng W, Wang Z. A novel hand-assisted laparoscopic versus conventional laparoscopic right hemicolectomy for right colon cancer: study protocol for a randomized controlled trial. Trials. 2017;18:355. doi: 10.1186/s13063-017-2084-3.
    1. Kim IY, Kim BR, Kim YW. The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer. Surg Endosc. 2016;30:1508–1518. doi: 10.1007/s00464-015-4364-x.
    1. Athanasiou CD, Markides GA, Kotb A, Jia X, Gonsalves S, Miskovic D. Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Color Dis. 2016;18:O224–O235. doi: 10.1111/codi.13385.
    1. Arezzo A, Passera R, Ferri V, Gonella F, Cirocchi R, Morino M. Laparoscopic right colectomy reduces short-term mortality and morbidity. Results of a systematic review and meta-analysis. Int J Color Dis. 2015;30:1457–1472. doi: 10.1007/s00384-015-2304-9.
    1. Munkedal DL, West NP, Iversen LH, Hagemann-Madsen R, Quirke P, Laurberg S. Implementation of complete mesocolic excision at a university hospital in Denmark: an audit of consecutive, prospectively collected colon cancer specimens. Eur J Surg Oncol. 2014;40:1494–1501. doi: 10.1016/j.ejso.2014.04.004.
    1. Tagliacozzo S, Tocchi A. Extended mesenteric excision in right hemicolectomy for carcinoma of the colon. Int J Color Dis. 1997;12:272–275. doi: 10.1007/s003840050104.
    1. Laparoscopic versus open complete mesocolic excision with central vascular ligation in right colon cancer. Shady, K.M. Available at:
    1. Ozben V, De Muijnck C, Esen E, Aytac E, Baca B, Karahasanoglu T, Hamzaoglu I. Is robotic complete mesocolic excision feasible for transverse colon cancer? J Laparoendosc Adv Surg Tech A. 2018;28:1443–1450. doi: 10.1089/lap.2018.0239.
    1. Bae SU, Yang SY, Min BS. Totally robotic modified complete mesocolic excision and central vascular ligation for right-sided colon cancer: technical feasibility and mid-term oncologic outcomes. Int J Color Dis. 2019;34:471–479. doi: 10.1007/s00384-018-3208-2.
    1. Mike M, Kano N. Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity. Surg Today. 2015;45:129–139. doi: 10.1007/s00595-014-0857-9.
    1. West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol. 2008;9:857–865. doi: 10.1016/S1470-2045(08)70181-5.
    1. Garcia-Granero A, Pellino G, Giner F, Frasson M, Grifo Albalat I, Sánchez-Guillén L, Valverde-Navarro AA, Garcia-Granero E. A proposal for novel standards of histopathology reporting for D3 lymphadenectomy in right colon cancer: the mesocolic sail and superior right colic vein landmarks. Dis Colon Rectum. 2020;63:450–460. doi: 10.1097/DCR.0000000000001589.
    1. Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, Mills S. Outcomes of laparoscopic colorectal surgery: data from the nationwide inpatient sample 2009. Am J Surg. 2012;204(6):952–957. doi: 10.1016/j.amjsurg.2012.07.031.
    1. Belizon A, Sardinha CT, Sher ME. Converted laparoscopic colectomy: what are the consequences? Surg Endosc. 2006;20(6):947–951. doi: 10.1007/s00464-005-0553-3.
    1. Spinoglio G, Bianchi PP, Marano A, Priora F, Lenti LM, Ravazzoni F, Petz W, Borin S, Ribero D, Formisano G, Bertani E. Robotic versus laparoscopic right colectomy with complete mesocolic excision for the treatment of colon cancer: perioperative outcomes and 5-year survival in a consecutive series of 202 patients. Ann Surg Oncol. 2018;25:3580–3586. doi: 10.1245/s10434-018-6752-.
    1. Yozgatli TK, Aytac E, Ozben V, Bayram O, Gurbuz B, Baca B, Balik E, Hamzaoglu I, Karahasanoglu T, Bugra D. Robotic complete mesocolic excision versus conventional laparoscopic hemicolectomy for right-sided colon cancer. J Laparoendosc Adv Surg Tech A. 2019;29:1–6. doi: 10.1089/lap.2018.
    1. McCombie AM, Frizelle F, Bagshaw PF, Frampton CM, Hewett PJ, McMurrick PJ, Rieger N, Solomon MJ, Stevenson AR. The ALCCaS trial: a randomized controlled trial comparing quality of life following laparoscopic versus open colectomy for colon cancer. Dis Colon Rectum. 2018;61:1156–1162. doi: 10.1097/DCR.0000000000001165.
    1. Głowacka-Mrotek I, Tarkowska M, Nowikiewicz T, Jankowski M, Mackiewicz-Milewska M, Hagner W, Zegarski W. Prospective evaluation of the quality of life of patients undergoing surgery for colorectal cancer depending on the surgical technique. Int J Color Dis. 2019;34:1601–1610. doi: 10.1007/s00384-019-03357-4.

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