Sir Thomas Browne Academic Colorectal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
Colorectal Dis. 2021 Jul;23(7):1670-1686. doi: 10.1111/codi.15644. Epub 2021 May 14.
Complete mesocolic excision (CME) lacks consistent data advocating operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analysis, analysing population characteristics and perioperative, pathological and oncological outcomes.
D3 extended lymphadenectomy dissection was considered comparable to CME, and D2 and D1 dissection to be comparable to conventional surgery. Outcomes reviewed included lymph node yield, R1 resection, overall complications, overall survival and disease-free survival.
In all, 3039 citations were identified; 148 studies underwent full-text reviews and 31 matched inclusion criteria: total cohort 26 640 patients (13 830 CME/D3 vs. 12 810 conventional). Overall 3- and 5-year survival was higher in the CME/D3 group compared with conventional surgery: relative risk (RR) 0.69 (95% CI 0.51-0.93, P = 0.016) and RR 0.78 (95% CI 0.64-0.95, P = 0.011) respectively. Five-year disease-free survival also demonstrated CME/D3 superiority (RR 0.67, 95% CI 0.52-0.86, P < 0.001), with similar findings at 1 and 3 years. There were no statistically significant differences between the CME/D3 and conventional group in overall complications (RR 1.06, 95% CI 0.97-1.14, P = 0.483) or anastomotic leak (RR 1.02, 95% CI 0.81-1.29, P = 0.647).
Meta-analysis suggests CME/D3 may have a better overall and disease-free survival compared to conventional surgery, with no difference in perioperative complications. Quality of evidence regarding survival is low, and randomized control trials are required to strengthen the evidence base.
与传统手术相比，完整结肠系膜切除术（CME）缺乏支持其手术优越性的一致性数据。我们进行了系统评价和荟萃分析，分析了人群特征以及围手术期、病理和肿瘤学结局。
D3 扩大淋巴结切除术被认为与 CME 相当，D2 和 D1 切除术与传统手术相当。评估的结果包括淋巴结产量、R1 切除、总并发症、总生存率和无病生存率。
共确定了 3039 条引文；148 项研究进行了全文审查，31 项研究符合纳入标准：总队列 26640 例患者（13830 例 CME/D3 与 12810 例传统手术）。与传统手术相比，CME/D3 组的总 3 年和 5 年生存率更高：相对风险（RR）分别为 0.69（95%可信区间 0.51-0.93，P=0.016）和 0.78（95%可信区间 0.64-0.95，P=0.011）。5 年无病生存率也显示出 CME/D3 的优势（RR 0.67，95%可信区间 0.52-0.86，P<0.001），1 年和 3 年的结果相似。CME/D3 组与传统组在总并发症（RR 1.06，95%可信区间 0.97-1.14，P=0.483）或吻合口漏（RR 1.02，95%可信区间 0.81-1.29，P=0.647）方面无统计学差异。
荟萃分析表明，与传统手术相比，CME/D3 可能具有更好的总体生存率和无病生存率，且围手术期并发症无差异。关于生存质量的证据质量较低，需要进行随机对照试验来加强证据基础。
