Minimally invasive complete mesocolic excision versus conventional right hemicolectomy for right-sided colon cancer: a systematic review and meta-analysis

BACKGROUND AND AIMS: There is insufficient evidence to support the application of complete mesocolic excision (CME) in minimally invasive surgery for right-sided colonic cancer. This meta-analysis was conducted to evaluate the efficacy and safety of minimally invasive CME compared with conventional right hemicolectomy for right-sided colonic cancer. METHODS: In adherence to PRISMA guidelines, 13 studies were included in the analysis (comprising 3 randomized controlled trials and 10 cohort studies, involving a total of 3,743 patients). Key outcomes assessed included lymph node yield, operative metrics, complication profiles, and survival outcomes. RESULTS: Minimally invasive CME demonstrated significantly higher lymph node retrieval (mean difference MD: 6.09, 95% CI: 3.48-8.70, p < 0.001), a lower incidence of anastomotic leakage (0.87% vs. 1.86%, risk ratio RR: 0.49, 95% CI: 0.24-0.94), improved 3-year overall survival (85.4% vs. 82.2%, RR: 1.05, 95% CI: 1.00-1.10), and 3-year disease-free survival (93.8% vs. 89.4%, RR: 1.04, 95% CI: 1.01-1.07) compared with conventional right hemicolectomy. Although the operative time was longer for CME (MD: 67.84 min, p < 0.001), no significant differences were observed between groups regarding other complication rates or intraoperative blood loss. Subgroup analyses revealed comparable outcomes between laparoscopic and robotic approaches. CONCLUSION: Minimally invasive CME offers superior oncological outcomes, particularly in terms of lymph node dissection and survival, without compromising short-term safety. Despite certain limitations, including insufficient long-term survival data and variability in adjuvant therapy reporting, CME represents a promising strategy for the treatment of right-sided colon cancer.