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

Published version
Peer-reviewed

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Authors

Anania, Gabriele 
Arezzo, Alberto 
Davies, Richard Justin 
Marchetti, Francesco  ORCID logo  https://orcid.org/0000-0001-8052-125X
Zhang, Shu 

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.

Description

Funder: Università degli Studi di Ferrara

Keywords

CME colectomy, Laparoscopic surgery, Open surgery, Right hemicolectomy, China, Colectomy, Colonic Neoplasms, Humans, Laparoscopy, Length of Stay, Lymph Node Excision, Mesocolon, Neoplasm Recurrence, Local, Operative Time, Treatment Outcome

Journal Title

Int J Colorectal Dis

Conference Name

Journal ISSN

0179-1958
1432-1262

Volume Title

36

Publisher

Springer Science and Business Media LLC