Laparoscopic versus open complete mesocolic excision: a systematic review by updated meta-analysis

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Colorectal Cancer Treatment

Background:

• Laparoscopic complete mesocolic excision (LCME) has demonstrated non-inferiority to open complete mesocolic excision (OCME) in feasibility and oncological safety.
• However, comparative survival benefits between LCME and OCME remain underexplored.

Purpose of the Study:

• To conduct an updated meta-analysis comparing the survival outcomes of LCME versus OCME.
• To determine if one surgical approach offers superior survival benefits in patients undergoing complete mesocolic excision.

Main Methods:

• Systematic literature search across major databases (PubMed, Embase, Cochrane, Google Scholar).
• Inclusion of retrospective studies and one randomized controlled trial comparing LCME and OCME.
• Meta-analysis using fixed- and random-effects models, assessing survival via inverse variance hazard ratio (HR).

Main Results:

• LCME demonstrated significantly shorter operative times, reduced blood loss, fewer wound infections, and faster postoperative recovery (flatus, feeding, hospital stay) compared to OCME.
• LCME was associated with significantly better 1-, 3-, and 5-year overall survival rates.
• While 1-year disease-free survival (DFS) showed no difference, LCME exhibited superior 3- and 5-year DFS rates.

Conclusions:

• Laparoscopic complete mesocolic excision is linked to expedited postoperative recovery and enhanced survival benefits over open complete mesocolic excision.
• Findings suggest LCME may offer superior long-term oncological outcomes, though results should be interpreted cautiously due to study limitations (retrospective, single-center).