Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25–4.86; 95%;p= 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.
全胃系膜切除术（CME）被认为能够更广泛地清扫淋巴结，同时降低局部区域复发率。本研究旨在分析联合CME的D2根治性胃切除术与标准D2胃切除术的短期疗效。根据Cochrane指南对截至2023年7月2日的文献进行了系统综述（PROSPERO ID：CRD42023443361）。主要结局指标以均数差（MD）和95%置信区间（CI）表示，为清扫淋巴结（LNs）数量。采用随机效应模型对均值和二分类结局进行荟萃分析以评估异质性。纳入研究的偏倚风险通过RoB 2和ROBINS-I工具评估。共纳入13项研究，涉及2009例患者，结果显示CME组清扫淋巴结平均数量显著更高（MD：2.55；95% CI：0.25–4.86；p=0.033）。CME组术中失血量、住院时间和手术时间均显著降低。三项研究存在严重偏倚风险，研究间异质性多为中度或高度。联合CME的根治性胃切除术可能提供更安全且更彻底的淋巴结清扫，但其长期疗效及该技术在西方国家的适用性仍有待验证。
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