Complete Mesocolic Excision (CME) versus Conventional RT Hemicolectomy (CRH) in Patients with Right Sided Colon Cancer: A Systematic Review and Meta-Analysis
Authors: El-Fatah Mohamed Kandil Abd , El-Maksoud Ibrahim Magid Abd , Hafez Karim Mohamed Ali 
Published: August 2023

Abstract

Background
We live in an era with improved worldwide average living standards and increased access to adequate healthcare that has considerably improved the diagnosis and treatment of diseases. These measures have had an impact on average life expectancy in most regions of the world.

Aim of the Work
The aim of this study is to perform a systematic review and meta-analysis to investigate safety and long-term out- comes of Complete Mesocolic Excision (CME) Versus Conventional RT Hemicolectomy (CRH) in patients with right sided colon cancer.

Materials and Methods
This study is a systematic review and meta-analysis. Literature search, study design, and data analysis were performed following PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Five medical databases were used in this research: MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science, and Embase. The keyword was as follows: ―complete mesocolic excision.‖ I select studies published up to December 2020. I select only articles written in English and we did not include abstracts or unpublished data. After literature search, 30 studies have been recorded. Screening by titles and abstracts led to the identification of 20 possibly relevant articles. Of these records, 8 studies were excluded because patients with distal transverse and/or left colon cancer were also evaluated. Moreover, in 3 studies, only the most recently record was selected. Lastly, 8 studies, published between 2010 and 2020, met inclusion criteria. All selected studies were observational; 4 of them were prospective. Overall, 1762 patients were enrolled in qualitative and quantitative analysis, 700 in the CME group and 1062 in the CRH group.

Results
Postoperative complications were reported in 9 studies showing that no difference was observed between techniques. Six studies separately analyzed surgical and non-surgical postoperative complications. No significant variation was reported between the 2 groups in the 2 different types of complications (surgical complications OR 1.09, 95% CI 0.72–1.63, p = 0.69, no surgical complications OR 1.37, 95% CI 0.79–2.36, p = 0.26, respectively). No significant difference was al- so observed between the two groups in terms of anastomotic leakage, while a significant negative median was reported for intraoperative bleeding in favor of CME group. 4 studies evaluated the procedure time which was significantly shorter for CRH, although heterogeneity levels among studies was high. The analysis of postoperative length of stay showed no difference between the two groups of patients. Number of lymph node yield was reported in 8 studies. The pooled analysis of 1762 patients found a positive median retrieval of 9.17 in CME group. High heterogeneity among the included studies was detected. Seven studies reported data of 3-year OS with a significant OS benefit in CME group. This data was characterized by moderate between-study heterogeneity. Furthermore, 76.4% of patients undergoing CME surgery were alive at 5 years, compared with 68.2% of CRH. Meta-analysis of 3 studies reporting 5-year DFS con- firmed the significant DFS benefit for patients undergoing CME. No significant heterogeneity was observed between the 3 studies.

Conclusion
My study confirm that CME with CVL associated with D3 lymphadectomy in right-side colon cancer improved not only staging but also prognosis, particularly in II and III stage; CME was a significant independent predictive factor for disease-specific survival at 3 years and 5 years compared with CRH associated with D2 lymphadectomy. CME is a safe and reproducible procedure with acceptable morbi-mortality.