Anatomical dissection approaches in right hemicolectomy with complete mesocolic excision: characteristics of surgical...

Several anatomical dissection approaches have been proposed for right hemicolectomy (RHC) with complete mesocolic excision (CME). Even though all are considered safe, the evidence-based guiding selection remains limited. We aimed to systematically review the literature and perform a Bayesian network meta-analysis to compare their relative characteristics.

A comprehensive search of PubMed, Embase, and the Cochrane Library was completed through August 2025. Eligible studies included adult patients undergoing minimally invasive RHC with CME, with the predominant dissection direction defined as medial-to-lateral (MtL), lateral-to-medial (LtM), cranial-to-caudal (CtC), or caudal-to-cranial, also known as the bottom-to-up (BtU) approach. The primary outcome was the number of harvested lymph nodes (LNs). Secondary outcomes included operative time, blood loss, and conversion to open surgery.

Fourteen studies including 2,947 patients were analyzed (MtL: 1,539; LtM: 401; CtC: 291; BtU: 716). No significant pairwise differences were observed in lymph node harvest, although ranking analysis indicated that BtU was the most favorable approach. Secondary outcomes did not show any significant differences, although BtU tended to reduce operative time as compared to MtL. LtM ranked worst and was associated with a significantly higher open conversion rate versus BtU (RR: 26.84, 95% CrI: 2.29-2014.36) and MtL (RR: 8.27, 95% CrI: 1.07-216.68).

No significant differences in LN harvest were observed among the four approaches. The BtU approach showed a non-significant trend toward a shorter operative time, whereas LtM was associated with a significantly higher rate of conversion to open surgery. Overall, the available evidence does not demonstrate clear superiority of any single approach, and further prospective studies are needed to confirm these findings.