Clinical efficacy and safety of complete mesocolic excision in the treatment of colon cancer

doi:10.3877/cma.j.issn.1674-0793.2020.02.019

Abstract

Abstract:

Objective

To evaluate the safety, sample quality and long-term prognosis of complete mesocolic excision (CME) for colorectal cancer.

Methods

The relevant documents published in PubMed, ScienceDirect, Cochrane, Scopus, CNKI and Wanfang databases were searched by computer from the establishment of the database to December 2018. The results of safety, quality and long-term survival were extracted.

Results

A total of 8 914 patients from 15 studies were included in this Meta-analysis. Compared with non-complete mesocolic excision (NCME) group, CME group had more complications (RR=1.23, 95% CI: 1.08-1.40), more lymph nodes (WMD=8.42, 95% CI: 4.71-12.13), longer distance from tumor to high ligation of blood vessels (WMD=18.43, 95% CI: 16.18-20.69), larger area of mesentery (WMD=35.07, 95% CI: 12.78-57.36). The 3-, 5- year survival rates of the patients in CME group were both higher (HR=0.72, 95% CI: 0.61-0.86; HR=0.55, 95% CI: 0.42-0.73; both P<0.01).

Conclusion

CME can effectively improve the quality of surgical specimens and prolong the long-term survival rate, but the incidence of surgical complications is high, so the safety of operation should be concerned.

Key words: Colonic neoplasms, Colectomy, Meta-analysis, Complete mesocolic excision

Shaoyong Wang, Zhongmin Zhang, Guanghui Wang. Clinical efficacy and safety of complete mesocolic excision in the treatment of colon cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(02): 154-160.

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Figures/Tables 8

References 29

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纳入研究(发表年)	研究时间(年)	国家	MINORS评分	分期^a	病例量(例)^b	年龄(岁) ^b	性别(%)^b,c	右半结肠癌占比(%)^b
West (2010)^[11]	1999—2008	德国	11	Ⅰ~Ⅳ	49/40	-	49/48	61/40
West (2010)^[12]	2008—2009	丹麦	13	Ⅰ~Ⅳ	93/170	70/72	60/44	44/34
Bertelsen (2011)^[13]	2007—2009	丹麦	13	Ⅰ~Ⅳ	93/105	70/73	56/50	50/57
Galizia (2014)^[14]	2004—2012	意大利	14	A~D	45/58	67/68	49/57	100/100
Storli (2014)^[15]	2007—2008	挪威	15	Ⅰ~Ⅲ	84/105	73/73	52/51	45/44
Siani (2015)^[16]	2008—2013	意大利	11	Ⅰ~Ⅲ	75/40	-	-	100/100
Bernhoff (2015)^[17]	2001—2008	瑞典	13	Ⅰ~Ⅲ	684/625	75/75	40/45	100/100
Bertelsen (2015)^[18]	2008—2011	丹麦	12	Ⅰ~Ⅲ	364/1 031	72/73	52/46	46/44
Bertelsen (2016)^[19]	2008—2013	丹麦	13	Ⅰ~Ⅲ	529/1 701	72/73	51/47	47/46
Merkel (2016)^[20]	1978—2014	德国	14	Ⅰ~Ⅲ	1 099/920	66/65	59/52	31/17
Thorsen(2016)^[21]	2007—2014	挪威	14	-	49/49	67/65	39/41	100/100
Agalianos (2017)^[22]	2006—2011	希腊	14	Ⅰ~Ⅲ	145/145	68/72	61/54	29/40
Gao (2018)^[6]	2012—2016	中国	14	Ⅰ~Ⅲ	220/110	68/73	55/49	58/52
Gian (2018)^[23]	2001—2014	瑞士	14	Ⅰ~Ⅳ	71/84	74/74	55/50	85/82
Abdelkhalek (2018)^[7]	2010—2015	埃及	13	Ⅰ~Ⅳ	52/79	66/58	50/52	48/49

纳入研究(发表年)	研究时间(年)	国家	MINORS评分	分期^a	病例量(例)^b	年龄(岁) ^b	性别(%)^b,c	右半结肠癌占比(%)^b
West (2010)^[11]	1999—2008	德国	11	Ⅰ~Ⅳ	49/40	-	49/48	61/40
West (2010)^[12]	2008—2009	丹麦	13	Ⅰ~Ⅳ	93/170	70/72	60/44	44/34
Bertelsen (2011)^[13]	2007—2009	丹麦	13	Ⅰ~Ⅳ	93/105	70/73	56/50	50/57
Galizia (2014)^[14]	2004—2012	意大利	14	A~D	45/58	67/68	49/57	100/100
Storli (2014)^[15]	2007—2008	挪威	15	Ⅰ~Ⅲ	84/105	73/73	52/51	45/44
Siani (2015)^[16]	2008—2013	意大利	11	Ⅰ~Ⅲ	75/40	-	-	100/100
Bernhoff (2015)^[17]	2001—2008	瑞典	13	Ⅰ~Ⅲ	684/625	75/75	40/45	100/100
Bertelsen (2015)^[18]	2008—2011	丹麦	12	Ⅰ~Ⅲ	364/1 031	72/73	52/46	46/44
Bertelsen (2016)^[19]	2008—2013	丹麦	13	Ⅰ~Ⅲ	529/1 701	72/73	51/47	47/46
Merkel (2016)^[20]	1978—2014	德国	14	Ⅰ~Ⅲ	1 099/920	66/65	59/52	31/17
Thorsen(2016)^[21]	2007—2014	挪威	14	-	49/49	67/65	39/41	100/100
Agalianos (2017)^[22]	2006—2011	希腊	14	Ⅰ~Ⅲ	145/145	68/72	61/54	29/40
Gao (2018)^[6]	2012—2016	中国	14	Ⅰ~Ⅲ	220/110	68/73	55/49	58/52
Gian (2018)^[23]	2001—2014	瑞士	14	Ⅰ~Ⅳ	71/84	74/74	55/50	85/82
Abdelkhalek (2018)^[7]	2010—2015	埃及	13	Ⅰ~Ⅳ	52/79	66/58	50/52	48/49

纳入研究(发表年)	病例量(例)		手术时间(min) ^a		术中出血量(ml)^a		并发症［例(%)］		术后病死率［例(%)］
纳入研究(发表年)	CME	NCME	CME	NCME	CME	NCME	CME	NCME	CME	NCME
Gao (2018)^[6]	220	110	175±10	180±11	80±8	110±25	43(19.5)	14(12.7)	-	-
Abdelkhalek (2018)^[7]	52	79	135±8	180±18	105±5	200±25	2(3.8)	5(6.3)	-	-
Bertelsen (2011)^[13]	105	93	-	-	250±256	217±356	19(18.1)	14(15.1)	6(5.7)	8(8.6)
Galizia (2014)^[14]	45	58	178±21	130±20	280±40	200±30	6(13.3)	7(12.1)	-	-
Bertelsen (2016)^[19]	529	1 701	-	-	-	-	110(20.8)	329(19.3)	33(6.2)	83(4.9)
Merkel (2016)^[20]	1 099	920	-	-	-	-	234(21.3)	143(15.5)	30(2.7)	25(2.7)
Gian (2018)^[23]	71	84	174±48	155±52	100±127	300±658	-	-	5(7.0)	0(0)

纳入研究(发表年)	病例量(例)		手术时间(min) ^a		术中出血量(ml)^a		并发症［例(%)］		术后病死率［例(%)］
纳入研究(发表年)	CME	NCME	CME	NCME	CME	NCME	CME	NCME	CME	NCME
Gao (2018)^[6]	220	110	175±10	180±11	80±8	110±25	43(19.5)	14(12.7)	-	-
Abdelkhalek (2018)^[7]	52	79	135±8	180±18	105±5	200±25	2(3.8)	5(6.3)	-	-
Bertelsen (2011)^[13]	105	93	-	-	250±256	217±356	19(18.1)	14(15.1)	6(5.7)	8(8.6)
Galizia (2014)^[14]	45	58	178±21	130±20	280±40	200±30	6(13.3)	7(12.1)	-	-
Bertelsen (2016)^[19]	529	1 701	-	-	-	-	110(20.8)	329(19.3)	33(6.2)	83(4.9)
Merkel (2016)^[20]	1 099	920	-	-	-	-	234(21.3)	143(15.5)	30(2.7)	25(2.7)
Gian (2018)^[23]	71	84	174±48	155±52	100±127	300±658	-	-	5(7.0)	0(0)

纳入研究(发表年)	病例量(例)		切除肠管的长度(mm)^a		肿瘤到血管高位结扎处的距离(mm) ^a		切除系膜面积(mm²)^a		清扫淋巴结总数(个)^a
纳入研究(发表年)	CME	NCME	CME	NCME	CME	NCME	CME	NCME	CME	NCME
Gao (2018)^[6]	220	110	208±11	212±13	144±26	121±28	131±8	91±6	24±3	20±2
Abdelkhalek (2018)^[7]	52	79	-	-	-	-	-	-	23±4	12±1
West (2010)^[11]	49	40	-	-	-	-	-	-	30±4	18±3
West (2010)^[12]	93	170	315±30	247±13	105±33	84±25	145±88	87±35	28±2	18±2
Bertelsen (2011)^[13]	92	80	-	-	96±34	71±22	-	-	27±1	25±1
Galizia (2014)^[14]	45	58	288±27	274±41	106±13	87±17	-	-	20±9	15±6
Storli (2014)^[15]	84	40	262±145	274±192	-	-	-	-	16±10	15±7
Siani (2015)^[16]	75	40	235±37	213±25	103±5	87±9	154±16	141±12	29±5	19±7
Bertelsen (2015)^[18]	364	1 031	-	-	-	-	-	-	36.5±15.9	20.9±10
Bertelsen (2016)^[19]	529	1 701	-	-	-	-	-	-	36±4	20±2
Thorsen (2016)^[21]	49	49	242±72	232±73	-	-	-	-	38±13	21±9
Gian (2018)^[23]	71	84	-	-	-	-	-	-	32±17	23±13

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