Tzanis Alexander A, Carrano Francesco Maria, Perivoliotis Konstantinos, Kumar Sunjay S, Christogiannis Christos, Mavridis Dimitris, Huo Bright, Bouvy Nicole, Christou Niki, Dore Suzanne, Dulskas Audrius, Kontovounisios Christos, Lubbers Tim, Palazzo Francesco, Quirke Philip, Repana Dimitra, Terlizzo Monica, Slater Bethany J, Florez Ivan D, Ortenzi Monica, Arulampalam Tan, Antoniou Stavros A
1st Department of Obstetrics and Gynaecology, Alexandra University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Guidelines Committee, European Association for Endoscopic Surgery, Eindhoven, Netherlands.
Surg Endosc. 2025 Jun;39(6):3466-3473. doi: 10.1007/s00464-025-11749-7. Epub 2025 May 5.
Complete mesocolic excision (CME) is a surgical approach for right-sided colon cancer, involving the resection of the primary tumour along with an intact mesocolon, central vascular ligation, and exposure of the superior mesenteric vein. It has been postulated to improve oncologic outcomes such as disease-free survival and reduce local recurrence compared to standard right colectomy. However, the clinical benefits are still debated.
This systematic review and meta-analysis, sponsored by the European Association for Endoscopic Surgery, aims to compare the oncologic outcomes of CME with standard right colectomy for right-sided colon cancer, with the ultimate objective to inform clinical practice recommendations.
We followed the PRISMA 2020 reporting standards. A comprehensive literature search was conducted to identify relevant studies published from 2008 onwards, focusing on randomised trials and matched cohort studies comparing CME with standard right hemicolectomy. The GRADE methodology was used to assess the certainty of evidence, and minimal important differences were calculated to inform clinical relevance.
Thirteen studies, amongst which three randomised trials, were included. No difference was found between CME and standard colectomy in terms of 30-day mortality, major peri-operative morbidity, or major blood loss. However, patients who underwent CME showed improved overall survival (HR = 0.67, 95%CI [0.48 - 0.93], low certainty of evidence) and disease-free survival (HR = 0.78, 95% CI [0.63 - 0.96], low certainty of evidence) compared to those who underwent standard colectomy, though certainty of the evidence was low due to the high risk of bias in the observational studies.
Complete mesocolic excision may offer survival benefits over standard right colectomy for right-sided colon cancer. However, the evidence remains of low certainty, mainly due to the predominance of observational data with significant risk of bias. Future high-quality randomized trials are needed to confirm these findings and standardize surgical techniques to reduce heterogeneity and improve clinical outcomes.
完整结肠系膜切除术（CME）是一种针对右侧结肠癌的手术方法，包括切除原发肿瘤及完整的结肠系膜、结扎中央血管以及暴露肠系膜上静脉。与标准右半结肠切除术相比，推测其可改善无病生存期等肿瘤学结局并降低局部复发率。然而，其临床益处仍存在争议。
这项由欧洲内镜外科学会发起的系统评价和荟萃分析旨在比较CME与标准右半结肠切除术治疗右侧结肠癌的肿瘤学结局，最终目的是为临床实践建议提供依据。
我们遵循PRISMA 2020报告标准。进行了全面的文献检索，以识别2008年以后发表的相关研究，重点关注比较CME与标准右半结肠切除术的随机试验和匹配队列研究。采用GRADE方法评估证据的确定性，并计算最小重要差异以说明临床相关性。
纳入了13项研究，其中包括3项随机试验。在30天死亡率、围手术期主要并发症或主要失血量方面，CME与标准结肠切除术之间未发现差异。然而，与接受标准结肠切除术的患者相比，接受CME的患者总体生存期（HR = 0.67，95%CI [0.48 - 0.93]，证据确定性低）和无病生存期（HR = 0.78，95%CI [0.63 - 0.96]，证据确定性低）有所改善，不过由于观察性研究存在高偏倚风险，证据的确定性较低。
对于右侧结肠癌，完整结肠系膜切除术可能比标准右半结肠切除术具有生存益处。然而，证据的确定性仍然较低，主要是因为观察性数据占主导且存在显著偏倚风险。需要未来高质量的随机试验来证实这些发现，并规范手术技术以减少异质性并改善临床结局。
