The role of complete mesocolic excision with central vascular ligation in colon cancer surgery: A systematic review and meta-analysis of prospective trials.

BACKGROUND

The concept of complete mesocolic excision (CME) with central vascular ligation (CVL) has been introduced as a surgical technique for colon cancer. Nonetheless, the precise significance of CME and CVL in improving outcomes remains a subject of ongoing debate. The objective of this systematic review and meta-analysis of prospective trials is to compare postoperative and oncological outcomes between CME with CVL and surgery without the concept of CME + CVL in patients with colon cancer.

MATERIALS AND

METHODS

A systematic literature search and meta-analyses were performed to evaluate both postoperative and oncological outcomes. Postoperative outcomes included operative time, intraoperative blood loss, conversion rate to open surgery, intraoperative and postoperative morbidity and mortality, and length of postoperative hospital stay. Oncological outcomes included disease-free survival (DFS), overall survival (OS), and the cumulative incidence of recurrence and death.

RESULTS

A total of 11 studies met the inclusion criteria, including six randomized controlled trials and five prospective clinical trials, comprising a total of 4575 patients (2244 in the CME + CVL group and 2331 in the non-CME + CVL group). Pooled analyses demonstrated significantly improved DFS and OS in the CME + CVL group, with no significant heterogeneity across studies. Additionally, there were no significant differences between the two groups in terms of postoperative outcomes, including morbidity and mortality.

CONCLUSIONS

This systematic review and meta-analysis demonstrated that CME with CVL significantly improves long-term oncological outcomes in patients with colon cancer, without compromising short-term postoperative outcomes. CME with CVL may represent an optimal surgical strategy for the management of colon cancer.