Clinical outcome of laparoscopic vs open right hemicolectomy for colon cancer: A propensity score matching analysis of the Japanese National Clinical Database

Abstract

Aim The advantages of laparoscopic right hemicolectomy over open surgery for colon cancer in general clinical practice are debated, as evidenced by the continued use of open surgery in a significant proportion of patients worldwide. This study aimed to assess and compare the clinical outcome of laparoscopic and open right hemicolectomy for colon cancer using data from the Japanese National Clinical Database. Methods A total of 72 299 patients who underwent laparoscopic (n = 46 084) and open (n = 26 215) right hemicolectomy for colon cancer between 2014 and 2018 were enrolled in this retrospective study. Short‐term outcome was compared between groups using propensity score matching analysis. Results The incidence of overall postoperative morbidity ≥ Clavien‐Dindo classification grade 3 was significantly higher in the open surgery group than the laparoscopic group (4.7% vs 3.2%, P < .001). The incidence of most individual morbidities, including surgical site infection, anastomotic leakage, and ileus, was higher in the open surgery group. Short‐term outcomes, including intraoperative blood loss, postoperative hospital stay, reoperation rate, 30‐day mortality, and in‐hospital mortality, were superior in the laparoscopic group, except for operative time. Subgroup analyses showed that the incidence of postoperative morbidity was lower in the laparoscopic group for all prespecified subgroups. Conclusion Laparoscopic right hemicolectomy has an advantage over open surgery for colon cancer with respect to short‐term outcome.

High Ligation of the Inferior Mesenteric Artery Induces Hypoperfusion of the Sigmoid Colon Stump During Anterior Resection

“…The AL rate varies widely and depends on the anatomic location of the anastomosis. The reported AL rate after laparoscopic ICR and right hemicolectomy ranges from 1 to 2.6% (29)(30)(31), whereas the AL rate after only laparoscopic AR without defunctioning stoma ranges from 6% to more than 10% (32)(33)(34). In the present study, the AL rate was 7.7% after AR, which is similar to the rate reported in previous studies.…”

Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis

“… 4 , 5 , 9 , 10 , 11 The higher incidence of SBO after laparoscopic surgery for UC is in contrast with the lower incidence of SBO after laparoscopic surgery for colorectal cancer compared with open surgery. 12 This discrepancy is caused by the fact that the small intestine can more easily twist due to the increased movable space after TPC and decreased postoperative adhesions from laparoscopic surgery. 9 , 13 In our present study, very few patients underwent open surgery (5.9%), and thus there was no significant difference between the two groups.…”

“…Previously reported risk factors for SBO (including SOO) after TPC have included laparoscopic surgery, loop ileostomy, low BMI, rectus abdominus wall thickness at the stoma‐penetrating site, HOS, and the distance from the ileal pouch inlet to the loop‐ileostomy (<30 cm) 4,5,9–11 . The higher incidence of SBO after laparoscopic surgery for UC is in contrast with the lower incidence of SBO after laparoscopic surgery for colorectal cancer compared with open surgery 12 . This discrepancy is caused by the fact that the small intestine can more easily twist due to the increased movable space after TPC and decreased postoperative adhesions from laparoscopic surgery 9,13 .…”

Laparoscopic Surgery for Acute Diffuse Peritonitis Due to Gastrointestinal Perforation: A Nationwide Epidemiologic Study Using the National Clinical Database

“…Elective laparoscopic surgery is now widely performed for both benign and malignant disease because it is less invasive than open surgery and postoperative recovery is more rapid 1‐3 . Laparoscopy has been reported to be useful in various surgical procedures, including gastrectomy and colectomy 4‐7 . However, its usefulness in the emergency setting is still unclear.…”

“… 1 , 2 , 3 Laparoscopy has been reported to be useful in various surgical procedures, including gastrectomy and colectomy. 4 , 5 , 6 , 7 However, its usefulness in the emergency setting is still unclear. Laparoscopic surgery requires an experienced surgeon, a patient in stable condition, and appropriate equipment, not all of which are possible when emergency surgery is required.…”