title: Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Several studies report improved survival in colon cancer with use of extended lymphadenectomy techniques (ELTs), such as D3 lymphadenectomy or complete mesocolic excision. The noninferiority of laparoscopic versus open techniques has already been established in D2 resections. The aim of this study was to compare the safety and efficacy of open and laparoscopic approaches for ELTs in colon cancer.
  
  
  METHODS
  Major databases, including PubMed, Scopus and the Cochrane library, were searched using defined inclusion and exclusion criteria, and relevant data were extracted. The Cochrane and Newcastle-Ottawa tools were used for critical appraisal and quality assessment. Meta-analysis with various subgroup analyses were undertaken, and clinical and statistical heterogeneity, along with publication bias, were also assessed.
  
  
  RESULTS
  One randomized and seven case-control trials were included. All studies were found to be of low methodological quality with some external validity issues. There was no difference in short-term mortality [OR = 2.16 (95% CI: 0.73-6.41); P = 0.16], anastomotic leakage, ileus or deep-sited infection/abscess. There was a trend for longer operative time [weighted mean difference (WMD) = -30.88 (95% CI: -62.38 to 0.61); P = 0.05] and shorter length of hospital stay [WMD = 2.29 (95% CI: -0.39 to 4.98); P = 0.09] with the laparoscopic approach. Laparoscopic right hemicolectomy had a lower wound-infection rate [OR = 2.87 (95% CI: 1.38-5.98); P = 0.005] compared with the relevant open group. No statistically significant difference was found in overall survival [hazard ratio (HR) = 0.85 (95% CI: 0.69-1.06); P = 0.15], disease-free survival, local recurrence and distant metastases.
  
  
  CONCLUSIONS
  Based on the current evidence, the laparoscopic technique appears to be at least as safe as the open technique when used in performing ELTs for colonic cancer, with similar morbidity and oncological outcomes.
authors.affiliation: John Goligher Colorectal Unit, St James' University Hospital, The Leeds Teaching Hospitals, Leeds, UK.
authors.forename: C D
authors.initials: CD
authors.lastname: Athanasiou
authors.affiliation: John Goligher Colorectal Unit, St James' University Hospital, The Leeds Teaching Hospitals, Leeds, UK.
authors.forename: G A
authors.initials: GA
authors.lastname: Markides
authors.affiliation: John Goligher Colorectal Unit, St James' University Hospital, The Leeds Teaching Hospitals, Leeds, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kotb
authors.affiliation: John Goligher Colorectal Unit, St James' University Hospital, The Leeds Teaching Hospitals, Leeds, UK.
authors.forename: X
authors.initials: X
authors.lastname: Jia
authors.affiliation: John Goligher Colorectal Unit, St James' University Hospital, The Leeds Teaching Hospitals, Leeds, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gonsalves
authors.affiliation: John Goligher Colorectal Unit, St James' University Hospital, The Leeds Teaching Hospitals, Leeds, UK.|The Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Miskovic
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D016022:Case-Control Studies; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008646:Mesocolon / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D061646:Operative Time; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: CME/D3; colonic cancer; extended lymphadenectomy techniques