Objective: To investigate and compare the clinical efficacy and prognosis of D3 lymphadenectomy/complete mesocolic excision in treatment of right colon cancer with different medial boundaries. Methods: We searched The Cochrane Library, Pubmed, Embase, CBM, VIP, CNKI, and WanFang data bases for superior mesenteric artery (SMA)-oriented and superior mesenteric vein (SMV)-oriented D3 lymphadenectomy/complete mesocolic excision from inception to December, 2023. The resultant data were submitted to meta-analysis using RevMan 5.3 software. Results: In total, we identified nine eligible studies involving 2467 patients. The SMA group had 982 patients and the SMV group had 1 485 patients. Meta-analysis revealed no significant differences in intraoperative bleeding volume, postoperative time to passage of flatus, or postoperative drainage volume between the two studied approaches. The durations of surgery and of postoperative hospital stay were both significantly longer in the SMA than SMV group (weighted mean difference [WMD]=17.70, 95%CI: 6.90-28.50, P=0.001; WMD=0.40, 95%CI: 0.07-0.72, P=0.020, respectively). Furthermore, the rate of postoperative complications was greater in the SMA than SMV group. For example, the incidences of postoperative chyle leakage and diarrhea were significantly higher in the SMA than SMV group, (OR=1.25, 95%CI: 1.01-1.54, P = 0.040; OR=3.60, 95%CI: 2.39-5.41, P < 0.001; OR=2.13, 95%CI: 1.10-4.11, P = 0.020, respectively). In terms of oncological efficacy, the total number of lymph nodes dissected and the number of positive lymph nodes in the SMA group were significantly higher than in the SMV group (WMD=2.76, 95%CI:1.22-4.31, P < 0.001, WMD=0.59, 95%CI: 0.06-1.12, P = 0.030). Conclusion: Laparoscopic surgery for right colon cancer, using the left margin of the SMA as the medial boundary for dissection is associated with a higher risk of postoperative complications, such as chyle leakage and diarrhea, than is using the superior mesenteric vein as the medial boundary. The durations of surgery and postoperative hospital stay are longer. SMA left margin dissection has significant oncological advantages, including a higher total number of harvested lymph nodes and of positive lymph nodes.
目的： 系统评价以肠系膜上动脉（SMA）左侧与以肠系膜上静脉（SMV）左侧不同内侧界在腹腔镜右半结肠癌D3淋巴结清扫术和完整结肠系膜切除术（CME）中的临床疗效和预后。 方法： 检索Cochrane图书馆、Pubmed数据库、Embase数据库、CBM数据库、维普数据库、中国知网和万方数据库等，收集国内外公开发表的关于腹腔镜右半结肠癌手术中比较以SMA为导向与以SMV为导向行D3或CME术后临床疗效的研究，检索时限为建库至2023年12月。采用RevMan 5.3软件进行Meta分析。若I²≤50%，则认为研究间的同质性较好，采用固定效应模型；若I²>50%，则认为研究间存在异质性，采用随机效应模型。 结果： 最终纳入9项研究，共2 467例患者。其中SMA组983例，SMV组1 485例。Meta分析结果显示，在腹腔镜右半结肠癌手术中，两种清扫内侧界在术中出血量、术后排气时间以及术后引流量方面比较，差异均无统计学意义（均P>0.05）。与SMV组比较，SMA组手术时间较长（WMD=17.70，95%CI：6.90~28.50，P=0.001），术后住院时间也较长（WMD=0.40，95%CI：0.07~0.72，P=0.020），差异均有统计学意义（均P<0.05）。术后并发症方面，与SMV组比较，SMA组总体并发症发生率较高（OR=1.25，95%CI：1.01~1.54，P=0.040），其中术后乳糜漏及腹泻发生率较高（OR=3.60，95%CI：2.39~5.41，P<0.001；OR=2.13，95%CI：1.10～4.11，P=0.020），差异均具有统计学意义（均P<0.05）。肿瘤学效果方面，与SMV组比较，SMA组淋巴结清扫总数和淋巴结阳性数目均较多（WMD=2.76，95%CI：1.22~4.31，P<0.001；WMD=0.59，95%CI：0.06~1.12，P=0.030），差异均具有统计学意义（均P<0.05）。 结论： 腹腔镜右半结肠癌CME和D3术中，以SMA左侧缘为内侧界清扫，具有较高的术后乳糜漏及术后腹泻等并发症风险，手术时间及术后住院时间较长。以SMA左侧缘清扫在肿瘤学预后方面优势明显，具有较高的淋巴结拣获总数和阳性淋巴结数。.