Warning: fopen(/home/virtual/colon/journal/upload/ip_log/ip_log_2025-11.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 95 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 96 Comparison of chyle leakage between laparoscopic and open colectomy in patients with colon cancer: a systematic review and meta-analysis
Skip Navigation
Skip to contents

Ann Coloproctol : Annals of Coloproctology

OPEN ACCESS
SEARCH
Search
Advanced Search
mobile menu button

Articles

Page Path
HOME > Ann Coloproctol > Volume 41(4); 2025 > Article
Review
Minimally invasive surgery
 Comparison of chyle leakage between laparoscopic and open colectomy in patients with colon cancer: a systematic review and meta-analysis
Tharin Thampongsa1orcid, Sitanun Saengsri1, Pichet Wattanapreechanoni1orcid, Chairat Supsamutchai1orcid, Chumpon Wilasrusmee1orcid, Napaphat Poprom2orcid
Annals of Coloproctology 2025;41(4):262-270.
DOI: https://doi.org/10.3393/ac.2025.00045.0006
Published online: August 27, 2025

1Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

2Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand

Correspondence to: Napaphat Poprom, PhD Faculty of Public Health, Chiang Mai University, 239 Huay Kaew Rd, Muang District, Chiang Mai 50200, Thailand Email: napaphat.p@cmu.ac.th
• Received: January 20, 2025   • Revised: May 27, 2025   • Accepted: May 28, 2025

© 2025 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next
  • 2,021 Views
  • 337 Download
Full Article

Download PDF Download PDF

  • Purpose
    Laparoscopic complete mesocolon excision (LCME) for right colonic cancer improves oncological outcomes. This meta-analysis aimed to compare the rate of chylous leakage between laparoscopic and open right colectomy with CME for right-sided colonic cancers.
  • Methods
    A literature search was performed up to February 2022. The primary outcome was the rate of chylous leakage. Secondary outcomes included related surgical and clinical parameters. A meta-analysis was performed to calculate risk ratios.
  • Results
    Eleven studies were included. The rate of postoperative chylous leakage was lower in laparoscopic surgery compared to open surgery (risk ratio, 0.63; 95% confidence interval, 0.33–1.20), although this difference was not statistically significant. LCME showed superior outcomes to open CME (OCME) in secondary outcomes, such as reduced blood loss, increased harvested lymph node count, and decreased overall morbidity.
  • Conclusion
    There was no significant difference between LCME and OCME regarding the rates of chylous leakage, anastomosis leakage, or operative time. However, LCME demonstrated superiority in blood loss reduction, harvested lymph node number, and overall morbidity in patients undergoing surgery for right colon cancer.
  • Keywords: Right colectomy; Colectomy; Laparoscopy; Surgery; Leakage
Colon cancer remains a significant cause of morbidity and mortality worldwide [1]. Extended lymphadenectomy with complete mesocolic excision (CME) yields the best outcomes in patients with colorectal cancer [2–4]. Therefore, CME is currently applied in many countries, including in Asia [5]. CME with excision of the D3 lymph nodes is the gold standard for both stage II and III colorectal cancer [6–9]. Laparoscopic surgery is usually performed in patients for whom it is safe and feasible [9, 10]. Laparoscopic CME (LCME) with central vascular ligation has technical advantages compared to the open approach and facilitates better postoperative recovery. In contrast, open CME (OCME) has shown advantages regarding postoperative bleeding, intraoperative morbidity, duration of surgery, and overall survival in some studies [11, 12].
Multiple studies have compared LCME and OCME outcomes for right colon cancer, typically involving small patient cohorts, particularly in Asian populations [13–22]. Few studies have directly compared the incidence of postoperative chylous leakage. However, existing literature suggests that chylous ascites after gastrointestinal surgery—including gastric, colorectal, pancreatic, and small bowel procedures—occurs at rates ranging from 1.0% to 11.8% [23, 24]. Specifically, the incidence of chylous ascites after excision for right-sided colon cancer has been reported as approximately 7.3%. Subgroup analyses evaluating prognostic nutritional index (≤47), laparoscopic approach, longer operative duration (>225 minutes), and estimated blood loss (>90 mL) have shown higher incidences: approximately 62.5%, 87.5%, 56.3%, and 47.9%, respectively [25]. Chylous leakage prolongs hospital stay by necessitating treatments such as parenteral nutrition or a medium-chain triglyceride diet. Moreover, existing evidence lacks specific comparative data on chylous leakage between LCME and OCME [24].
Therefore, this systematic review and meta-analysis aimed to compare postoperative chylous leakage and clinical outcomes between open and laparoscopic right hemicolectomy with CME for right-sided colon cancer.
The systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [26], and the protocol was registered in PROSPERO (No. CRD42022315168).
Search strategy for identification of studies
Studies were identified through comprehensive searches of the PubMed, Hindawi, Embase, and Google Scholar databases up to February 2022, structured according to the following PICO (population, intervention, comparison, and outcome) criteria:
• P: “complete mesocolon excision,” “cancer,” “right colon,” “ascending colon,” “transverse colon,” “surgery”
• I: “minimally invasive,” “laparoscopy,” “laparoscopic”
• C: “open,” “colectomy,” “resection”
• O: “lymphatic leakage,” “chyle leakage,” “chylous ascites”
The inclusion criteria were studies published in English that compared outcomes between laparoscopic and open operations involving oncologic resection with CME, specifically in human subjects.
Study selection
Eligible cohort studies met the following inclusion criteria: (1) patients diagnosed with right-sided colon or transverse colon cancer undergoing right hemicolectomy with CME; (2) comparative studies between laparoscopic and open colectomy for right-sided colon cancer; and (3) studies reporting outcomes related to chylous leakage and published in the English language.
Interventions and outcomes of interest
Interventions comprised laparoscopic, laparoscopic hand-assisted, or open right hemicolectomy procedures with CME or D3 lymphadenectomy. The extent of tissue excision was anatomically defined by 4 connecting landmark lines: the cranial border lies proximally and parallel to the gastrocolic trunk of Henle and middle colic artery line; the medial border is located at the left side of the superior mesenteric artery; the caudal border connects the confluence of the ileocolic artery and vein; and the lateral border runs parallel to the right side of the superior mesenteric vein [27–29].
The primary outcome, chylous leakage, was defined as the presence of a noninfectious, white-milky discharge through the abdominal drain, characterized by triglyceride levels exceeding 1.3 mmol/L and lower cholesterol levels [27].
The secondary outcomes included the following: (1) operative time, measured as skin-to-skin duration in minutes; (2) overall morbidity, defined as the rate of surgical and medical complications occurring within 30 days postoperatively; (3) estimated blood loss, reported as the volume of blood loss in milliliters; (4) anastomotic leak rate, defined as leakage of luminal contents from a surgical anastomosis between 2 hollow viscera [30]; and (5) number of harvested lymph nodes, defined as the total lymph nodes retrieved from the surgical specimen.
Data extraction and risk of bias assessments
Two reviewers (SS and PW) independently screened abstracts and full texts. Extracted variables included country of origin, year of study publication, study design, patient demographics (age, sex, body mass index [BMI]), tumor size, chylous leakage, operative time, overall morbidity, estimated blood loss, anastomotic leak rate, and the total number of harvested lymph nodes. The methodological quality of included studies was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scale [31], comprising 12 methodological items rated by assigned scores.
Statistical analysis
The risk ratios (RRs) for dichotomous outcomes (i.e., chylous leakage, overall morbidity, and anastomotic leakage) and mean differences (MDs) along with variances for continuous outcomes (i.e., operative time, estimated blood loss, and harvested lymph node count) were pooled across studies. Heterogeneity among studies was evaluated using the Cochrane Q test and the I2 statistic. A fixed-effect model was applied when heterogeneity was not present; otherwise, a random-effects model was employed. To explore sources of heterogeneity, meta-regression analysis was performed by individually adding covariates such as sex, BMI, age, and tumor size, with subsequent checks on the τ2 statistics. Publication bias was assessed through funnel plots and the Egger test. A 2-sided P-value <0.05 was considered statistically significant. Additionally, the nonparametric trim-and-fill method described by Duval and Tweedie [32] was used to evaluate potential publication bias; the analysis indicated no evidence of missing studies.
The PRISMA flow diagram is presented in Fig. 1. The initial literature search yielded 1,988 studies. After removing duplicates, 872 citations remained. Following screening of titles, abstracts, and full texts, 861 studies were excluded due to irrelevant subjects, unrelated outcomes of interest, noncomparative designs, or nonrandomized controlled trial (non-RCT) methodologies. Ultimately, 11 studies met the inclusion criteria for meta-analysis [14–16, 18, 33–39].
Study characteristics
All included studies were observational (Table 1) [14–16, 18, 33–39]. Among these, 2 were prospective studies [38, 39]. Ten studies (involving 1,446 patients) originated from Asia [14–16, 18, 33–38], while 1 study (involving 96 patients) originated from the West [38]. The overall mean age ranged from 56.0 to 75.1 years, the mean BMI ranged from 21.7 to 25.1 kg/m2, and the mean tumor size ranged from 4.4 to 7.6 cm. Male patients accounted for approximately 46.6% to 69.6% of participants.
Risk of bias assessment
Risk of bias was evaluated using the MINORS scale, designed for assessing the quality of non-RCT studies. The mean MINORS score was 16, indicating moderate risk.
Outcomes of interest

Chyle leakage

The direct meta-analysis included data from 11 studies with 1,542 patients [14–16, 18, 33–39]. The results indicated a lower rate of postoperative chyle leakage in laparoscopic surgery compared to open surgery, with a pooled RR of 0.63 (95% confidence interval [CI], 0.33 to 1.20); however, this difference was not statistically significant (Fig. 2) [14–16, 18, 33–39]. A sensitivity analysis conducted by excluding studies based on country, study design, and weighting percentages yielded pooled RRs of 0.61 (95% CI, 0.32 to 1.19), 0.64 (95% CI, 0.32 to 1.26), and 0.94 (95% CI, 0.35 to 2.55), respectively (Supplementary Fig. 1) [14–16, 18, 33–39]. Additionally, no publication bias was detected according to the Egger test and funnel plots (coefficient, –1.090; standard error [SE], 0.877; P=0.214) (Fig. 3).

Anastomosis leakage

Eight studies with 1,282 patients compared the rate of anastomosis leakage between laparoscopic and open surgery [14–16, 33–35, 37, 39]. The results indicated a nonsignificantly lower rate of anastomosis leakage in the laparoscopic group, with a pooled RR of 0.83 (95% CI, 0.39 to 1.76) (Fig. 4) [14–16, 33–35, 37, 39]. A sensitivity analysis conducted by excluding studies based on country, study design, and weighting percentage produced pooled RRs of 0.88 (95% CI, 0.40 to 1.94), 0.88 (95% CI, 0.40 to 1.94), and 0.78 (95% CI, 0.35 to 1.74), respectively (Supplementary Fig. 2) [14–16, 33–35, 37, 39]. No evidence of publication bias was observed (coefficient, –0.140; SE, 0.834; P=0.864) (Fig. 5).

Blood loss

Data retrieved from 9 studies involving 1,100 patients were analyzed to compare MDs in blood loss between the 2 surgical interventions [14, 16, 18, 33, 34, 36–39]. Estimated blood loss was significantly lower in laparoscopic surgery (MD, –0.49; 95% CI, –0.83 to –0.15) (Supplementary Fig. 3A) [14, 16, 18, 33, 34, 36–39]. Due to high heterogeneity (I2=86.32%), meta-regression was conducted, suggesting that age, BMI, and tumor size contributed to this heterogeneity, as indicated by reductions in τ2 statistics from 0.199, 0.046, and 0.175, respectively. Subgroup analysis was not conducted due to insufficient data. Publication bias was a concern, indicated by significant Egger test results and funnel plot asymmetry (coefficient, –8.270; SE, 3.444; P=0.016) (Supplementary Fig. 3B). However, the nonparametric trim-and-fill method indicated no missing studies (MD, –0.37; 95% CI, –0.49 to –0.25). Thus, observed bias was likely attributable to heterogeneity rather than publication bias.

Harvested lymph nodes

Data from 8 studies including 1,039 patients compared harvested lymph node counts [15, 16, 18, 34, 36–39]. Laparoscopic surgery showed higher number of harvested lymph nodes (MD, 0.06; 95% CI, –0.24 to 0.37) but was not statistical significant (Supplementary Fig. 4A) [15, 16, 18, 34, 36–39]. Due to high heterogeneity (I2=81.50%), meta-regression analysis was performed, indicating sex as a significant source of heterogeneity. Additionally, no publication bias was detected based on the Egger test and funnel plots (Supplementary Fig. 4B).

Overall morbidity

Six studies comprising 868 patients, were analyzed for postoperative morbidity [14, 15, 35–38]. Laparoscopic surgery had significantly lower overall morbidity rates compared to open surgery (RR, 0.59; 95% CI, 0.43 to 0.80) (Supplementary Fig. 5A) [14, 15, 35–38]. Funnel plots and the Egger test confirmed the absence of publication bias (Supplementary Fig. 5B).

Operative time

Operative time was analyzed from data provided by 8 studies, involving 930 patients [16, 18, 33, 34, 36–39]. Laparoscopic surgery exhibited longer operative time than open surgery with statistically significance (MD, 0.76; 95% CI, 0.28 to 1.23) (Supplementary Fig. 6A) [16, 18, 33, 34, 36–39]. Due to very high heterogeneity (I2=91.28%), meta-regression was conducted, suggesting sex and tumor size as sources of heterogeneity, as reflected by reductions in τ2 from 0.426 to 0.199 and 0.370, respectively. However, subgroup analysis was not performed due to insufficient studies. There was no indication of publication bias for operative time (Supplementary Fig. 6B).
This meta-analysis, comprising 11 studies with a total of 1,542 patients, compared LCME and OCME [14–16, 18, 33–39]. The findings demonstrated significantly better efficacy for LCME regarding blood loss and overall morbidity. However, no significant differences were observed for chylous leakage, anastomosis leakage, or operative time. Furthermore, only 1 included study originated from a Western country [39]. We therefore performed sensitivity analyses by excluding this Western study and found that the exclusion did not substantially affect any of the outcomes.
Chylous leakage following surgery typically originates in the mesentery due to injury to lymphatic vessels [28]. The concept underlying D3 lymphadenectomy involves extensive lymph node removal at the mesenteric root, potentially increasing the risk of lymphatic vessel injury and thus the incidence of chylous ascites. The incidence of chylous ascites varies significantly among types of abdominal surgery, particularly bowel surgery. The intestinal lymphatic flow mechanism responds primarily to dietary fat absorption; therefore, reduced fat intake leads to decreased lymphatic flow. Conservative treatment with fat-free diets or parenteral nutrition is typically recommended for patients with chylous ascites, although these interventions prolong hospitalization [40, 41].
Previous evidence suggests that postoperative hospital stay after LCME for colorectal cancer is shorter than that after OCME [5, 42]. Additionally, LCME provides better outcomes regarding time to first flatus, postoperative ambulation, and overall recovery compared to OCME.
In this meta-analysis, early postoperative morbidity was significantly lower in the laparoscopic group than in the open surgery group. In contrast, previous meta-analyses reported no significant difference in complication rates between LCME and OCME for colon cancer [43]. However, laparoscopic surgery was consistently associated with a significantly lower incidence of wound infections, potentially due to shorter incision length and reduced tissue exposure [42, 43].
Although our results support the benefits of LCME over OCME, it is critical to consider that laparoscopic procedures may require conversion to open surgery for various reasons, such as uncontrolled bleeding, extensive adhesions, or accidental organ injury. Surgeons should therefore clearly inform patients about potential outcomes associated with conversion, including longer hospital stays, extended operative times, and increased postoperative complications. These factors are essential in patient selection for laparoscopic surgery [44, 45].
The presented results indicate that the laparoscopic approach with CME for right-sided colon cancer is not inferior to the open approach. Additionally, patients treated laparoscopically showed a trend toward a lower 5-year systemic recurrence rate. Although these outcomes were reported by only a few studies and should be confirmed by more robust research, our findings align with several other meta-analyses [46, 47]. The difficulty, technical complexity, and prolonged learning curve associated with laparoscopic CME may partly explain these findings. Outcomes such as postoperative mortality, anastomotic leaks, chylous leaks, or pulmonary infections showed no statistically significant differences between laparoscopic and open surgery. Nevertheless, the clinical importance of these findings and expert opinion should be considered alongside statistical significance.
Limitations
This study had several limitations: (1) the geographic distribution of included studies may limit the generalizability of our results; (2) variations in surgical standards, adjuvant therapy protocols, and healthcare systems may have influenced the outcomes; (3) only observational studies were included, potentially introducing biases inherent in these designs; (4) the limited number of studies for each outcome may have reduced statistical power and affected the direction of results; and (5) high heterogeneity in some outcomes could not be explored fully through subgroup analyses due to an insufficient number of studies. Despite these limitations, our study possesses strengths, notably its comparative analysis of postoperative chylous leakage and clinical outcomes between open and laparoscopic CME for right-sided colon cancer, including studies from both Asian and Western populations. Future RCTs should aim to validate these findings and include subjects from Western populations to enhance generalizability. Moreover, subsequent studies should investigate long-term survival and recurrence rates in addition to short-term surgical outcomes.
Conclusions
LCME for right-sided colon cancer surgery demonstrates superiority over OCME in reducing blood loss, increasing the number of harvested lymph nodes, and lowering overall morbidity. However, no statistically significant differences were identified regarding chylous leakage, anastomotic leakage, or operative time. Further studies with greater statistical power and improved data quality are necessary to confirm and extend these findings.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: TT, CS, NP; Data curation: SS, PW; Formal analysis: NP; Investigation: TT, CS, CW, NP; Methodology: NP; Project administration: TT, CS, CW; Resources: TT, CS; Software: NP; Supervision: TT, CS, NP; Validation: SS, PW, NP; Visualization: TT, CS, CW, NP; Writing–original draft: SS, NP; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Supplementary Fig. 1.

Sensitivity of chyle leakage.
ac-2025-00045-0006-Supplementary-Fig-1.pdf

Supplementary Fig. 2.

Sensitivity of anastomosis leakage.
ac-2025-00045-0006-Supplementary-Fig-2.pdf

Supplementary Fig. 3.

Blood loss outcome.
ac-2025-00045-0006-Supplementary-Fig-3.pdf

Supplementary Fig. 4.

Number of harvested nodes outcome.
ac-2025-00045-0006-Supplementary-Fig-4.pdf

Supplementary Fig. 5.

Overall morbidity outcome.
ac-2025-00045-0006-Supplementary-Fig-5.pdf

Supplementary Fig. 6.

Operative time outcome.
ac-2025-00045-0006-Supplementary-Fig-6.pdf
Supplementary materials are available from https://doi.org/10.3393/ac.2025.00045.0006.
Fig. 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of the included studies. RCT, randomized controlled trial.
ac-2025-00045-0006f1.jpg
Fig. 2.
Forest plot of chyle leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. RR, risk ratio; CI, confidence interval.
ac-2025-00045-0006f2.jpg
Fig. 3.
Funnel plot of chyle leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. CI, confidence interval.
ac-2025-00045-0006f3.jpg
Fig. 4.
Forest plot of anastomosis leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. RR, risk ratio; CI, confidence interval.
ac-2025-00045-0006f4.jpg
Fig. 5.
Funnel plot of anastomosis leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. CI, confidence interval.
ac-2025-00045-0006f5.jpg
Table 1.
Baseline characteristics of the included studies
Study Study design Country Intervention No. of patients Mean age (yr) Male sex (%) Mean BMI (kg/m2) Mean tumor size (cm)
Kim et al. [33] (2016) Retrospective Korea LCME 116 69.0 46.6 23.5 4.8
OCME 99 67.0 55.6 22.8 6.2
Sheng et al. [16] (2017) Retrospective China LCME 78 60.1 55.1 21.7 NR
OCME 72 62.4 55.5 21.7 NR
Kim et al. [34] (2014) Retrospective Korea LCME 84 62.3 53.6 23.6 4.6
OCME 47 59.7 57.4 22.5 5.0
Sheng et al. [35] (2015) Retrospective China LCME 59 60.0 57.6 NR NR
OCME 59 61.0 54.2 NR NR
Kim et al. [36] (2015) Retrospective Korea LCME 79 65.7 57.0 24.0 5.2
OCME 23 56.0 69.6 22.6 7.6
Wang et al. [37] (2017) Retrospective China LCME 39 58.3 53.8 NR NR
OCME 39 57.5 51.3 NR NR
Bae et al. [14] (2014) Retrospective Korea LCME 85 64.0 53.0 22.8 4.5
OCME 85 65.0 55.0 22.7 5.0
Kang et al. [38] (2016) Prospective Korea LCME 43 65.7 51.2 23.3 4.4
OCME 33 68.4 63.6 23.2 5.5
Zedan et al. [39] (2021) Prospective Egypt LCME 48 NR NR NR 4.5
OCME 48 NR NR NR 5.6
Han et al. [15] (2014) Retrospective China LCME 177 67.0 46.9 NR NR
OCME 147 65.0 54.4 NR NR
Chen et al. [18] (2017) Retrospective China LCME 27 73.5 66.7 23.7 NR
OCME 55 75.1 61.8 25.1 NR

BMI, body mass index; LCME, laparoscopic complete mesocolon excision; OCME, open complete mesocolon excision; NR, not reported.

  • 1. Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10–30. ArticlePubMed
  • 2. Storli KE, Søndenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I, et al. Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol 2014;18:557–64. ArticlePubMedPDF
  • 3. Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 2015;16:161–8. ArticlePubMed
  • 4. Kontovounisios C, Kinross J, Tan E, Brown G, Rasheed S, Tekkis P. Complete mesocolic excision in colorectal cancer: a systematic review. Colorectal Dis 2015;17:7–16. Article
  • 5. Athanasiou CD, Markides GA, Kotb A, Jia X, Gonsalves S, Miskovic D. Open compared with laparoscopic complete mesocolic excision with central lymphadenectomy for colon cancer: a systematic review and meta-analysis. Colorectal Dis 2016;18:O224–35. ArticlePubMed
  • 6. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, et al. Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 2014;260:23–30. ArticlePubMed
  • 7. Inomata M, Katayama H, Mizusawa J, Watanabe M, Sugihara K, Konishi F, et al. A randomized controlled trial to evaluate laparoscopic versus open complete mesocolic excision (CME) for stage II, III colorectal cancer (CRC): first efficacy results from Japan Clinical Oncology Group Study JCOG0404. J Clin Oncol 2015;33(3_suppl):656.Article
  • 8. Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, et al. The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery: proceedings of a consensus conference. Int J Colorectal Dis 2014;29:419–28. ArticlePubMedPDF
  • 9. An MS, Baik H, Oh SH, Park YH, Seo SH, Kim KH, et al. Oncological outcomes of complete versus conventional mesocolic excision in laparoscopic right hemicolectomy. ANZ J Surg 2018;88:E698–702. ArticlePDF
  • 10. Young-Fadok TM, Nelson H. Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum 2000;43:267–73. ArticlePubMed
  • 11. Negoi I, Hostiuc S, Negoi RI, Beuran M. Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: a systematic review and meta-analysis. World J Gastrointest Oncol 2017;9:475–91. ArticlePubMedPMC
  • 12. Pedrazzani C, Lazzarini E, Turri G, Fernandes E, Conti C, Tombolan V, et al. Laparoscopic complete mesocolic excision for right-sided colon cancer: analysis of feasibility and safety from a single Western center. J Gastrointest Surg 2019;23:402–7. ArticlePDF
  • 13. Zhao LY, Chi P, Ding WX, Huang SR, Zhang SF, Pan K, et al. Laparoscopic vs open extended right hemicolectomy for colon cancer. World J Gastroenterol 2014;20:7926–32. ArticlePubMedPMC
  • 14. Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, et al. Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol 2014;21:2288–94. ArticlePubMedPDF
  • 15. Han DP, Lu AG, Feng H, Wang PX, Cao QF, Zong YP, et al. Long-term outcome of laparoscopic-assisted right-hemicolectomy with D3 lymphadenectomy versus open surgery for colon carcinoma. Surg Today 2014;44:868–74. ArticlePubMedPDF
  • 16. Sheng QS, Pan Z, Chai J, Cheng XB, Liu FL, Wang JH, et al. Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches. Ann Surg Treat Res 2017;92:90–6. ArticlePubMedPMCPDF
  • 17. Li T, Meng XL, Chen W. Safety and short-term efficacy of a laparoscopic complete mesocolic excision for the surgical treatment of right hemicolon cancer. Clin Surg Res Commun 2018;2:29–33. Article
  • 18. Chen Z, Sheng Q, Ying X, Chen W. Comparison of laparoscopic versus open complete mesocolic excision in elderly patients with right hemicolon cancer: retrospective analysis of one single cancer. Int J Clin Exp Med 2017;10:5116–24.PDF
  • 19. Huang JL, Wei HB, Fang JF, Zheng ZH, Chen TF, Wei B, et al. Comparison of laparoscopic versus open complete mesocolic excision for right colon cancer. Int J Surg 2015;23(Pt A):12–7. Article
  • 20. Shin JK, Kim HC, Lee WY, Yun SH, Cho YB, Huh JW, et al. Laparoscopic modified mesocolic excision with central vascular ligation in right-sided colon cancer shows better short- and long-term outcomes compared with the open approach in propensity score analysis. Surg Endosc 2018;32:2721–31. ArticlePubMedPMCPDF
  • 21. Guan GX, Liu X, Jiang WZ, Chen ZF, Lu HS. Short-term efficacy of laparoscopic-assisted right hemicolectomy with D3 lymph node dissection in colon cancer. Zhonghua Wei Chang Wai Ke Za Zhi 2010;13:917–20. Chinese. PubMed
  • 22. Kim IY, Kim BR, Kim YW. The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer. Surg Endosc 2016;30:1508–18. ArticlePubMedPDF
  • 23. Yol S, Bostanci EB, Ozogul Y, Ulas M, Akoglu M. A rare complication of D3 dissection for gastric carcinoma: chyloperitoneum. Gastric Cancer 2005;8:35–8. ArticlePubMedPDF
  • 24. Weniger M, D'Haese JG, Angele MK, Kleespies A, Werner J, Hartwig W. Treatment options for chylous ascites after major abdominal surgery: a systematic review. Am J Surg 2016;211:206–13. ArticlePubMed
  • 25. Sun Y, Deng Y, Lin Y, Lin H, Huang Y, Jiang W, et al. Chylous ascites after complete mesocolic excision for right-sided colon cancer with D3 lymphadenectomy: a retrospective cohort-study. Colorectal Dis 2022;24:461–9. ArticlePubMedPDF
  • 26. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009;6:e1000100. ArticlePubMedPMC
  • 27. Agustsdottir EE, Stimec BV, Stroemmen TT, Sheikh AE, Elaiyarajah I, Lindstroem JC, et al. Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy. Langenbecks Arch Surg 2020;405:1017–24. ArticlePubMedPMCPDF
  • 28. Spasojevic M, Stimec BV, Dyrbekk AP, Tepavcevic Z, Edwin B, Bakka A, et al. Lymph node distribution in the d3 area of the right mesocolon: implications for an anatomically correct cancer resection: a postmortem study. Dis Colon Rectum 2013;56:1381–7. ArticlePubMed
  • 29. Nesgaard JM, Stimec BV, Bakka AO, Edwin B, Ignjatovic D; RCC study group. Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy. Colorectal Dis 2015;17:810–8. ArticlePubMed
  • 30. Peel AL, Taylor EW. Proposed definitions for the audit of postoperative infection: a discussion paper. Surgical Infection Study Group. Ann R Coll Surg Engl 1991;73:385–8. PubMedPMC
  • 31. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003;73:712–6. ArticlePubMedPDF
  • 32. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455–63. ArticlePubMed
  • 33. Kim IY, Kim BR, Choi EH, Kim YW. Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation. Int J Surg 2016;27:151–7. ArticlePubMed
  • 34. Kim WR, Baek SJ, Kim CW, Jang HA, Cho MS, Bae SU, et al. Comparative study of oncologic outcomes for laparoscopic vs. open surgery in transverse colon cancer. Ann Surg Treat Res 2014;86:28–34. ArticlePubMedPMC
  • 35. Sheng W, Zhang B, Chen W, Gu D, Gao W. Laparoscopic colectomy for transverse colon cancer: comparative analysis of short- and long-term outcomes. Int J Clin Exp Med 2015;8:16029–35. PubMedPMC
  • 36. Kim MK, Won DY, Lee JK, Kang WK, Kye BH, Cho HM, et al. Laparoscopic surgery for transverse colon cancer: short- and long-term outcomes in comparison with conventional open surgery. J Laparoendosc Adv Surg Tech A 2015;25:982–9. ArticlePubMed
  • 37. Wang Y, Zhang C, Feng YF, Fu Z, Sun YM. Comparison of short-term outcomes between laparoscopic-assisted and open complete mesocolic excision (CME) for the treatment of transverse colon cancer. Chin Clin Oncol 2017;6:6.ArticlePubMed
  • 38. Kang J, Park YA, Baik SH, Sohn SK, Lee KY. A comparison of open, laparoscopic, and robotic surgery in the treatment of right-sided colon cancer. Surg Laparosc Endosc Percutan Tech 2016;26:497–502. ArticlePubMed
  • 39. Zedan A, Elshiekh E, Omar MI, Raafat M, Khallaf SM, Atta H, et al. Laparoscopic versus open complete mesocolic excision for right colon cancer. Int J Surg Oncol 2021;2021:8859879.ArticlePubMedPMCPDF
  • 40. Lv S, Wang Q, Zhao W, Han L, Wang Q, Batchu N, et al. A review of the postoperative lymphatic leakage. Oncotarget 2017;8:69062–75. ArticlePubMedPMC
  • 41. Al-Busafi SA, Ghali P, Deschênes M, Wong P. Chylous ascites: evaluation and management. ISRN Hepatol 2014;2014:240473.ArticlePubMedPMCPDF
  • 42. Pecorelli N, Amodeo S, Frasson M, Vignali A, Zuliani W, Braga M. Ten-year outcomes following laparoscopic colorectal resection: results of a randomized controlled trial. Int J Colorectal Dis 2016;31:1283–90. ArticlePubMedPDF
  • 43. Chand M, Siddiqui MR, Rasheed S, Brown G, Tekkis P, Parvaiz A, et al. A systematic review and meta-analysis evaluating the role of laparoscopic surgical resection of transverse colon tumours. Surg Endosc 2014;28:3263–72. ArticlePubMedPDF
  • 44. Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg 2012;204:952–7. ArticlePubMed
  • 45. Belizon A, Sardinha CT, Sher ME. Converted laparoscopic colectomy: what are the consequences? Surg Endosc 2006;20:947–51. ArticlePubMedPDF
  • 46. Chaouch MA, Dougaz MW, Bouasker I, Jerraya H, Ghariani W, Khalfallah M, et al. Laparoscopic versus open complete mesocolon excision in right colon cancer: a systematic review and meta-analysis. World J Surg 2019;43:3179–90. ArticlePubMedPDF
  • 47. Alhassan N, Yang M, Wong-Chong N, Liberman AS, Charlebois P, Stein B, et al. Comparison between conventional colectomy and complete mesocolic excision for colon cancer: a systematic review and pooled analysis: a review of CME versus conventional colectomies. Surg Endosc 2019;33:8–18. ArticlePubMedPDF

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      • Cite this Article
        Cite this Article
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Comparison of chyle leakage between laparoscopic and open colectomy in patients with colon cancer: a systematic review and meta-analysis
        Ann Coloproctol. 2025;41(4):262-270.   Published online August 27, 2025
        DOI: https://doi.org/10.3393/ac.2025.00045.0006
        Close
      • XML DownloadXML Download
      Figure
      • 0
      • 1
      • 2
      • 3
      • 4
      Related articles
      Comparison of chyle leakage between laparoscopic and open colectomy in patients with colon cancer: a systematic review and meta-analysis
      Image Image Image Image Image
      Fig. 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of the included studies. RCT, randomized controlled trial.
      Fig. 2. Forest plot of chyle leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. RR, risk ratio; CI, confidence interval.
      Fig. 3. Funnel plot of chyle leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. CI, confidence interval.
      Fig. 4. Forest plot of anastomosis leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. RR, risk ratio; CI, confidence interval.
      Fig. 5. Funnel plot of anastomosis leakage between open and laparoscopic right hemicolectomy with complete mesocolon excision in colon cancer. CI, confidence interval.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Fig. 4.

      Fig. 5.

      Comparison of chyle leakage between laparoscopic and open colectomy in patients with colon cancer: a systematic review and meta-analysis
      Study Study design Country Intervention No. of patients Mean age (yr) Male sex (%) Mean BMI (kg/m2) Mean tumor size (cm)
      Kim et al. [33] (2016) Retrospective Korea LCME 116 69.0 46.6 23.5 4.8
      OCME 99 67.0 55.6 22.8 6.2
      Sheng et al. [16] (2017) Retrospective China LCME 78 60.1 55.1 21.7 NR
      OCME 72 62.4 55.5 21.7 NR
      Kim et al. [34] (2014) Retrospective Korea LCME 84 62.3 53.6 23.6 4.6
      OCME 47 59.7 57.4 22.5 5.0
      Sheng et al. [35] (2015) Retrospective China LCME 59 60.0 57.6 NR NR
      OCME 59 61.0 54.2 NR NR
      Kim et al. [36] (2015) Retrospective Korea LCME 79 65.7 57.0 24.0 5.2
      OCME 23 56.0 69.6 22.6 7.6
      Wang et al. [37] (2017) Retrospective China LCME 39 58.3 53.8 NR NR
      OCME 39 57.5 51.3 NR NR
      Bae et al. [14] (2014) Retrospective Korea LCME 85 64.0 53.0 22.8 4.5
      OCME 85 65.0 55.0 22.7 5.0
      Kang et al. [38] (2016) Prospective Korea LCME 43 65.7 51.2 23.3 4.4
      OCME 33 68.4 63.6 23.2 5.5
      Zedan et al. [39] (2021) Prospective Egypt LCME 48 NR NR NR 4.5
      OCME 48 NR NR NR 5.6
      Han et al. [15] (2014) Retrospective China LCME 177 67.0 46.9 NR NR
      OCME 147 65.0 54.4 NR NR
      Chen et al. [18] (2017) Retrospective China LCME 27 73.5 66.7 23.7 NR
      OCME 55 75.1 61.8 25.1 NR
      Table 1. Baseline characteristics of the included studies

      BMI, body mass index; LCME, laparoscopic complete mesocolon excision; OCME, open complete mesocolon excision; NR, not reported.

      Table 1.

      Ann Coloproctol : Annals of Coloproctology Twitter Facebook
      © Korean Society of Coloproctology.
      TOP