D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis
Por:
Balciscueta, Z, Balciscueta, I, Uribe, N, Pellino, G, Frasson, M, Garcia-Granero, E and Garcia-Granero, A
Publicada:
1 jul 2021
Ahead of Print:
1 jun 2021
Resumen:
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.
(c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Filiaciones:
:
Hosp Arnau Vilanova, Colorectal Surg Unit, Valencia, Spain
:
Hosp Univ La Ribera, Dept Gen & Digest Surg, Valencia, Spain
:
Hosp Arnau Vilanova, Colorectal Surg Unit, Valencia, Spain
Pellino, G:
Univ Campania Luigi Vanvitelli, Dept Adv Med & Surg Sci, Naples, Italy
Vali dHebron Univ Hosp, Colorectal Surg, Barcelona, Spain
Frasson, M:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Garcia-Granero, E:
Hosp Univ & Politecn La Fe, Colorectal Surg Unit, Valencia, Spain
Garcia-Granero, A:
Hosp Univ Son Espases, Colorectal Surg Unit, Mallorca, Spain
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