Complete mesocolic excision for right colon cancer—state of art: a systematic review of the literature

Complete mesocolic excision (CME) is a new concept of right hemicolectomy for colon cancer (CC) set up to improve oncological outcomes and based on three main points: dissection in the embryological plane, central vascular ligation (CVL) and resection of a sufficient length of bowel. During this last decade, many doubts and questions have been arised about safety and efficacy of CME. We conducted a systematic review of the literature to investigate the safety, quality and survival outcomes of this procedure. Literature search resulted in 659 articles found and after the selection process 21 studies properly fulfilling inclusion and exclusion criteria were included. The total number of collected patients was 7,402 (mean age 65.42 years, 51.27% men). The weighted mean number of lymph nodes retrieved was 27.45 and the mean number of metastatic nodes was 1.34. Surgical complication and overall operative mortality rate were 5.5% and 0.5% respectively. Five-year overall survival (OS) and disease-free survival (DFS) rates were 84.3% and 82.8%. Available data from literature have several limitations mostly including non-homogeneous and incomplete reports together with no evidence from randomized control trial (RCT) studies. Therefore, to date, the quality of evidence is low and does not consistently support the superiority of CME over the standard right hemicolectomy, despite a reported trend to improved survival with comparable operative morbidity and mortality. More reliable data from large sample size RCTs are needed before CME can be recommended as the standard of care for right CC.