Minimally invasive complete mesocolic excision versus conventional right hemicolectomy for right-sided colon cancer: a systematic review and meta-analysis

There is insufficient evidence to support the application of complete mesocolic excision (CME) in minimally invasive surgery for right-sided colonic cancer. This meta-analysis was conducted to evaluate the efficacy and safety of minimally invasive CME compared with conventional right hemicolectomy for right-sided colonic cancer.

In adherence to PRISMA guidelines, 13 studies were included in the analysis (comprising 3 randomized controlled trials and 10 cohort studies, involving a total of 3,743 patients). Key outcomes assessed included lymph node yield, operative metrics, complication profiles, and survival outcomes.

Minimally invasive CME demonstrated significantly higher lymph node retrieval (mean difference [MD]: 6.09, 95% CI: 3.48-8.70, p < 0.001), a lower incidence of anastomotic leakage (0.87% vs. 1.86%, risk ratio [RR]: 0.49, 95% CI: 0.24-0.94), improved 3-year overall survival (85.4% vs. 82.2%, RR: 1.05, 95% CI: 1.00-1.10), and 3-year disease-free survival (93.8% vs. 89.4%, RR: 1.04, 95% CI: 1.01-1.07) compared with conventional right hemicolectomy. Although the operative time was longer for CME (MD: 67.84 min, p < 0.001), no significant differences were observed between groups regarding other complication rates or intraoperative blood loss. Subgroup analyses revealed comparable outcomes between laparoscopic and robotic approaches.

Minimally invasive CME offers superior oncological outcomes, particularly in terms of lymph node dissection and survival, without compromising short-term safety. Despite certain limitations, including insufficient long-term survival data and variability in adjuvant therapy reporting, CME represents a promising strategy for the treatment of right-sided colon cancer.