Laparoscopic versus open complete mesocolic excision: a systematic review by updated meta-analysis

Recent evidence has proven the non-inferiority of laparoscopic complete mesocolic excision (LCME) to open complete mesocolic excision (OCME) with regard to feasibility and oncological safety. However, the differences in survival benefits between the 2 procedures have not been assessed. The aim of this study was to evaluate whether or not one procedure was superior to the other using updated meta-analysis. A systematic search for relevant literature was performed in Pubmed, Embase, Cochrane library and Google scholar databases. This meta-analysis included retrospective studies and one randomised controlled trial comparing LCME to OSCME. LCME to OCME was evaluated using updated meta-analysis. The Newcastle-Ottawa scale was used to assess the methodologic quality of the studies. Fixed- and random-effects models were used, and survival outcomes were assessed using the inverse variance hazard ratio (HR) method. Operative time was significantly shorter in the OCME cohort than in the LCME cohort. Blood loss, wound infections, time to flatus, time to oral feeding, and length of hospital stay were significantly shorter in the LCME cohort than in the OCME cohort. The 1-, 3-, and 5-year overall survivals were better in the LCME cohort than in the OCME cohort ([HR = 0.37 (0.22, 0.65);p = 0.004], [HR = 0.48 (0.31, 0.74);p = 0.008], and [HR = 0.64 (0.45, 0.93);p = 0.02], respectively). No difference in the 1-year disease-free survival (DFS) between the 2 procedures was observed ([HR = 0.68 (0.44, 1.03);p = 0.07]). In contrast, the LCME cohort had better 3- and 5-year DFS rates than those of the OCME cohort ([HR = 0.63 (0.42, 0.97),p = 0.03] and [HR = 0.68 (0.56, 0.83),p = 0.001], respectively). The results of the present study must be interpreted cautiously because the included studies were retrospective from single centres. Therefore, selection, institutional and national bias may have influenced the results. LCME is associated with the faster postoperative recovery and some better potential survival benefits than OCME.