Abstract: Benz et al. reported outcomes from a prospective multicentre registry-based study1 of complete mesocolic excision (CME). We believe major methodological limitations mean this study should be interpreted with extreme caution. The aim of the study was to examine the difference between CME and non-CME surgery, but the definition of the observed cohort itself was inadequate. CME was defined by the operating surgeons' documentation stating that 'the SMV was dissected'. This criterion (on its own) is meaningless, as it neither provides definition of the resection extent nor CME quality markers.
It is concerning that the authors were unable to assess the intended primary outcome (disease-free survival) as data on recurrence were not available, perhaps due to a lack of a standardized follow-up. In previous studies, lower recurrence rates for all stages were reported. This study was flawed with data collection, selection, and reporting biases. Despite these flaws, the results indicate trends to improved overall survival (consistent with meta-analysis data) in all stages. For stage III, a significant higher overall (not disease-specific) survival was demonstrated. The conclusion that 'no general survival benefit from CME' can be found, or drawing any conclusions from its results, including the suggestion that CME should only be performed in clinical trials, are not based on scientific evidence.
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