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Meta-Analysis
. 2024 Dec 30;56(1):37.
doi: 10.1007/s12029-024-01162-z.

Preoperative CT-Scan Angiography Reconstruction Before Right Colectomy with Complete Mesocolon Excision: A Systematic Review and Meta-analysis

Mohamed Ali Chaouch  1 , Mohammad Iqbal Hussain  2 , Amine Gouader  3 , Bassem Krimi  3 , Alessandro Mazzotta  4 , Adriano Carneira Da Costa  5 , Ian Seiller  6 , Aymeric Guibal  6 , Mohamed Abdel Rehim  6 , Michele Diana  7   8   9 , Jacques Marescaux  7 , Jim Khan  2 , Wahid Fattal  10 , Hani Oweira  10
Affiliations
Meta-Analysis

Preoperative CT-Scan Angiography Reconstruction Before Right Colectomy with Complete Mesocolon Excision: A Systematic Review and Meta-analysis

Mohamed Ali Chaouch et al. J Gastrointest Cancer. .

Abstract

Background: Complete mesocolon excision (CME) and central vascular ligation for right colonic cancers have been developed to improve oncological outcomes. However, it has been linked with a higher risk of morbidity and technical difficulties in operating near major vessels. This study investigated the impact of preoperative surgical planning utilizing CT reconstruction on surgical outcomes in right colectomy with CME.

Methods: This systematic review and meta-analysis followed PRISMA and AMSTAR 2 guidelines. The analysis included clinical trials and observational studies comparing outcomes after preoperative CT scan reconstruction (navigation group) vs. no preoperative CT reconstruction (control group).

Results: Four eligible studies (published between 2013 and 2023) were included, comprising 420 patients (203 in the navigation group and 217 in the control group). Preoperative navigation was associated with significantly lower blood loss (SMD = - 77.50; 95% CI [- 126.77, - 28.22], p = 0.002), shorter operative time (SMD = - 24.44; 95% CI [- 33.33, - 15.55], p < 0.00001), and a higher number of harvested lymph nodes (SMD = 1.39; 95% CI [0.58, 2.20], p = 0.0007). There was no statistically significant difference between the two groups in terms of overall morbidity (OR = 0.82; 95% CI [0.28, 2.40], p = 0.71), intraoperative complications (OR = 1.39; 95% CI [0.37, 5.26], p = 0.63), anastomotic leak (OR = 1.10; 95% CI [0.16, 7.63], p = 0.92), or hospital stay (SMD = - 0.06; 95% CI [- 0.48, 0.37], p = 0.80).

Conclusion: Preoperative navigation using CT reconstruction could help better delineate the complex vascular anatomy of the right colon. It may reduce operative time and increase the yield of harvested lymph nodes.

Keywords: CT angiography; Central vascular ligation; Complete mesocolon excision; Meta-analysis; Outcomes; Right colectomy.

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Conflict of interest statement

Declarations. Ethics Approval and Consent to Participate: Not applicable. Consent for Publication: Not applicable. Competing Interests: The authors declare no competing interests.

References

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