N Alhassan, M Yang, N Wong-Chong, A S Liberman, P Charlebois, B L Stein, G M Fried, L Lee. McGill University Health Centre
Introduction: Complete mesocolic excision(CME) has been advocated based on oncologic superiority, but is not commonly performed in North America. Furthermore, many data are limited to case series with few comparative studies. Therefore the objective was to systematically review studies comparing the short- and long-term outcomes between CME and non-CME colectomy for colon cancer.
Methods: A systematic review was performed according to PRISMA guidelines of MEDLINE, EMBASE, HealthStar, Web of Science, and Cochrane Library. Studies were only included if they compared conventional resection (non-CME) to CME for colon cancer. Quality was assessed using the Methodological Index For Non-Randomized Studies (MINORS). The main outcome measures were short-term morbidity and oncologic outcomes. Study eligibility, data extraction and quality assessment was performed by two independent reviewers, and disagreements resolved by consensus. Weighted pooled means and proportions with 95%CI were calculated using a random-effects model when appropriate.
Results: Out of 825 citations, 23 studies underwent full-text review and 14 met the inclusion criteria, of which 10 were unique series. Mean MINORS score was 13.6(range 11-16). The mean sample size in the CME group was 1075(range 45-3756) and 785(range 40-3425) in the non-CME group. In the 10 unique studies, 4 included only right-sided resection, and 44.2%(95% CI 35.8-52.6) of the remaining 6 were right-sided colectomies. Of the 5 studies that reported surgical approach, 52.2%(95%CI 31.0-73.3) of CME were performed laparoscopically. There were 4 papers reporting plane of dissection, with CME plane achieved in 87.4%(79.7-95.2). Mean OR time in CME group was 167 minutes(range 163-171) and in non-CME group 138 minutes(range 135-142). Perioperative morbidity was reported in 6 studies, with pooled overall complications of 22.5%(95%CI 18.4–26.6) for CME and 19.6(95%CI 13.6–25.5) for non-CME resections. Anastomotic leak occurred in 6.0%(95%CI 2.2-9.7) of CME versus 6.0%(95%CI 4.1-7.9) in non-CME colectomies. CME surgery consistently resulted in more lymph nodes retrieved, longer distance to high tie, and specimen length. There were 7 studies that compared 3- or 5-year overall or disease-free survival, or local recurrence. Only 2 studies reported statistically significant higher disease-free or overall survival in favour of CME. Local recurrence was lower after CME in 1 of 4 reported studies.
Conclusions: The quality of the current evidence is limited and does not consistently support the superiority of CME. More rigorous data are needed before CME can be recommended as the standard of care for colon cancer resections.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86814
Program Number: P242
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster