Complete Mesocolic Excision Versus D2 Lymphadenectomy for Right Colon Cancer: A Bayesian Meta-Analysis of Randomized Trials Assessing Surgical and Perioperative Outcomes.
Bernardo Fontel Pompeu, Lucas Monteiro Delgado, Gabriel Leal Barone et al.
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In 30 seconds
This systematic review and Bayesian meta-analysis compared complete mesocolic excision (CME) with D2 lymphadenectomy for right colectomy in patients with right-sided colon cancer. It included three randomized trials involving 1,378 patients. CME yielded more lymph nodes than D2 (mean difference +3.9; 95% CI: 2.8 to 5.0; P < .001) and took longer (mean difference +11.6 minutes; 95% CI: 6.6 to 16.7; P < .001). The analyses found no significant differences in blood loss, complications, conversion, or 30-day mortality.
Key findings
- CME increased lymph node harvest by a mean difference of +3.9 (95% CI: 2.8 to 5.0; P < .001).
- Operative time was longer with CME by a mean difference of +11.6 minutes (95% CI: 6.6 to 16.7; P < .001).
- No significant differences were found in blood loss, overall or severe complications, intraoperative complications, conversion, or 30-day mortality.
- Bayesian modeling estimated a 95.9% probability of blood-loss equivalence within ± 50 mL.
Why it matters
The findings clarify the trade-off between greater nodal retrieval and longer operating time with CME, without detected differences in measured perioperative outcomes. This helps frame the oncologic and operative considerations when comparing these approaches, while the evidence remains based on a limited number of randomized trials.
What to keep in mind
The meta-analysis included only three randomized trials; the abstract does not report longer-term oncologic outcomes.