TY - JOUR
T1 - D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis
AU - Balciscueta, Zutoia
AU - Balciscueta, Izaskun
AU - Uribe, Natalia
AU - Pellino, Gianluca
AU - Frasson, Matteo
AU - García-Granero, Eduardo
AU - García-Granero, Álvaro
N1 - Publisher Copyright:
© 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2021/7
Y1 - 2021/7
N2 - Background: D3-Lymphadenectomy, together with complete mesocolic excision (CME), were introduced to provide oncological results after right colon cancer. The aim of this systematic review with meta-analysis was to assess the short and long-term outcomes of right-sided hemicolectomy with CME + D3 as compared with classic right hemicolectomy. Secondary aims included the prevalence of D3-metastasis and skip metastasis when performing CME + D3. Material and methods: A systematic review with meta-analysis was conducted, according to PRISMA methodology. Results: 29 studies were enrolled (2592 patients). No differences were accounted in morbidity variables associated with the measured techniques. CME + D3 was significantly associated with a greater distance between the tumour and the closest vascular tie, a longer colonic resection, a wider resection of mesentery and an increased number of harvested lymph nodes. Regarding to long-terms outcomes, we found a significant decrease in local recurrence in patients undergoing CME + D3 (HR:0.17) and a significant improvement in 3-year and 5-year overall survival rates (HR:0.53 vs. HR:0.57, respectively), as well as an improving survival in patients with stage II and III disease. Overall prevalence of patients with lymphatic metastases in D3-territory was of 8.6% and 2.2% of skip metastases. Conclusions: CME + D3 is a feasible surgical procedure that allows to obtain specimens with higher quality oncological resection, without greater associated morbidity, thus improving survival in patients with stage II and III right colon cancer.
AB - Background: D3-Lymphadenectomy, together with complete mesocolic excision (CME), were introduced to provide oncological results after right colon cancer. The aim of this systematic review with meta-analysis was to assess the short and long-term outcomes of right-sided hemicolectomy with CME + D3 as compared with classic right hemicolectomy. Secondary aims included the prevalence of D3-metastasis and skip metastasis when performing CME + D3. Material and methods: A systematic review with meta-analysis was conducted, according to PRISMA methodology. Results: 29 studies were enrolled (2592 patients). No differences were accounted in morbidity variables associated with the measured techniques. CME + D3 was significantly associated with a greater distance between the tumour and the closest vascular tie, a longer colonic resection, a wider resection of mesentery and an increased number of harvested lymph nodes. Regarding to long-terms outcomes, we found a significant decrease in local recurrence in patients undergoing CME + D3 (HR:0.17) and a significant improvement in 3-year and 5-year overall survival rates (HR:0.53 vs. HR:0.57, respectively), as well as an improving survival in patients with stage II and III disease. Overall prevalence of patients with lymphatic metastases in D3-territory was of 8.6% and 2.2% of skip metastases. Conclusions: CME + D3 is a feasible surgical procedure that allows to obtain specimens with higher quality oncological resection, without greater associated morbidity, thus improving survival in patients with stage II and III right colon cancer.
KW - Central vascular ligation
KW - Central vessel ligation
KW - Colon cancer
KW - Complete mesocolic excision
KW - D3 lymphadenectomy
KW - Right hemicolectomy
UR - http://www.scopus.com/inward/record.url?scp=85101957619&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2021.02.020
DO - 10.1016/j.ejso.2021.02.020
M3 - Review article
C2 - 33676793
AN - SCOPUS:85101957619
SN - 0748-7983
VL - 47
SP - 1541
EP - 1551
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 7
ER -
