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Meta-Analysis
. 2021 Aug;36(8):1609-1620.
doi: 10.1007/s00384-021-03891-0. Epub 2021 Mar 1.

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

Gabriele Anania  1 , Alberto Arezzo  2 , Richard Justin Davies  3 , Francesco Marchetti  4 , Shu Zhang  5 , Salomone Di Saverio  6 , Roberto Cirocchi  7 , Annibale Donini  7
Affiliations
Meta-Analysis

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

Gabriele Anania et al. Int J Colorectal Dis. 2021 Aug.

Abstract

Purpose: The aim of this study was to compare the outcomes of right hemicolectomy with CME performed with laparoscopic and open surgery.

Methods: PubMed, Scopus, Web of Science, China National Knowledge Infrastructure, Wanfang Data, Google Scholar and the ClinicalTrials.gov register were searched. Primary outcome was the overall number of harvested lymph nodes. Secondary outcomes were short and long-term course variables. A meta-analysis was performed to calculate risk ratios.

Results: Twenty-one studies were identified with 5038 patients enrolled. The difference in number of harvested lymph nodes was not statistically significant (MD 0.68, - 0.41-1.76, P = 0.22). The only RCT shows a significant advantage in favour of laparoscopy (MD 3.30, 95% CI - 0.20-6.40, P = 0.04). The analysis of CCTs showed an advantage in favour of the laparoscopic group, but the result was not statically significantly (MD - 0.55, 95% CI - 0.57-1.67, P = 0.33). The overall incidence of local recurrence was not different between the groups, while systemic recurrence at 5 years was lower in laparoscopic group. Laparoscopy showed better short-term outcomes including overall complications, lower estimated blood loss, lower wound infections and shorter hospital stay, despite a longer operative time. The rate of anastomotic and chyle leak was similar in the two groups.

Conclusions: Despite the several limitations of this study, we found that the median number of lymph node harvested in the laparoscopic group is not different compared to open surgery. Laparoscopy was associated with a lower incidence of systemic recurrence.

Keywords: CME colectomy; Laparoscopic surgery; Open surgery; Right hemicolectomy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow chart of literature search
Fig. 2
Fig. 2
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Overall number of harvested lymph nodes
Fig. 3
Fig. 3
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Operative time
Fig. 4
Fig. 4
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Intraoperative blood loss
Fig. 5
Fig. 5
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Anastomotic leak
Fig. 6
Fig. 6
Forest plot of comparison: Laparoscopic versus open CME right hemicolectomy. Chylous leak
See this image and copyright information in PMC

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