Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.
Austin Health, Melbourne, VIC, Australia.
Tech Coloproctol. 2023 Nov;27(11):995-1005. doi: 10.1007/s10151-023-02838-7. Epub 2023 Jul 7.
Complete mesocolic excision (CME) has been associated with improved oncological outcomes in treatment of colon cancer. However, widespread adoption is limited partly because of the technical complexity and perceived risks of the approach. The aim of out study was to evaluate the safety of CME compared to standard resection and to compare robotic versus laparoscopic approaches.
Two parallel searches were undertaken in MEDLINE, Embase and Web of Science databases 12 December 2021. The first was to evaluate IDEAL stage 3 evidence to compare complication rates as a surrogate marker of perioperative safety between CME and standard resection. The second independent search compared lymph node yield and survival outcomes between minimally invasive approaches.
There were four randomized control trials (n = 1422) comparing CME to standard resection, and three studies comparing laparoscopic (n = 164) to robotic (n = 161) approaches. Compared to standard resection, CME was associated with a reduction in Clavien-Dindo grade 3 or higher complication rates (3.56% vs. 7.24%, p = 0.002), reduced blood loss (113.1 ml vs. 137.6 ml, p < 0.0001) and greater mean lymph node harvest (25.6 vs. 20.9 nodes, p = 0.001). Between the robotic and laparoscopic groups, there were no significant differences in complication rates, blood loss, lymph node yield, 5-year disease-free survival (OR 1.05, p = 0.87) and overall survival (OR 0.83, p = 0.54).
Our study demonstrated improved safety with CME. There was no difference in safety or survival outcomes between robotic and laparoscopic CME. The advantage of a robotic approach may lie in the reduced learning curve and an increased penetration of minimally invasive approach to CME. Further studies are required to explore this.
CRD42021287065.
完整结肠系膜切除术（CME）已被证明可改善结肠癌的治疗效果。然而，由于该方法技术复杂且存在风险，其广泛应用受到限制。本研究旨在评估 CME 与标准切除术相比的安全性，并比较机器人手术与腹腔镜手术的效果。
我们于 2021 年 12 月 12 日在 MEDLINE、Embase 和 Web of Science 数据库中进行了两次平行检索。第一次是评估 IDEAL 分期 3 期的证据，以评估 CME 和标准切除之间的并发症发生率作为围手术期安全性的替代指标。第二次独立检索比较了微创方法的淋巴结产量和生存结果。
有四项随机对照试验（n=1422）比较了 CME 与标准切除术，有三项研究比较了腹腔镜（n=164）与机器人（n=161）方法。与标准切除术相比，CME 可降低 Clavien-Dindo 3 级或更高级别的并发症发生率（3.56%比 7.24%，p=0.002）、减少出血量（113.1ml 比 137.6ml，p<0.0001）和增加平均淋巴结收获量（25.6 个比 20.9 个，p=0.001）。在机器人和腹腔镜组之间，并发症发生率、出血量、淋巴结产量、5 年无病生存率（OR 1.05，p=0.87）和总生存率（OR 0.83，p=0.54）无显著差异。
我们的研究表明 CME 具有更高的安全性。机器人 CME 和腹腔镜 CME 在安全性或生存结果方面没有差异。机器人手术的优势可能在于减少学习曲线和增加对 CME 的微创方法的应用。需要进一步研究来探索这一点。
CRD42021287065。
