Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches

Abstract

PurposeTo demonstrate the feasibility, safety, and technical strategies of hand-assisted laparoscopic complete mesocolic excision (HAL-CME) and to compare oncological outcomes between HAL-CME and the open approach (O-CME) for right colon cancers.MethodsPatients who were scheduled to undergo a right hemicolectomy were divided into HAL-CME and O-CME groups. Measured outcomes included demographic variables, perioperative parameters, and follow-up data. Demographic variables included age, sex distribution, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, previous abdominal surgery, tumor localization, and potential comorbidities. Perioperative parameters included incision length, operative time, blood loss, conversion rate, postoperative pain score, postoperative first passage of flatus, duration of hospital stay, total cost, number of lymph nodes retrieved, TNM classification, and postoperative complications. Follow-up data included follow-up time, use of chemotherapy, local recurrence rate, distant metastasis rate, and short-term survival rate.ResultsIn total, 150 patients (HAL-CME, 78; O-CME, 72) were included. The groups were similar in age, sex distribution, BMI, ASA classification, history of previous abdominal surgeries, tumor localization, and potential comorbidities. Patients in the HAL-CME group had shorter incision lengths, longer operative times, less operative blood loss, lower pain scores, earlier first passage of flatus, shorter hospital stay, higher total costs, similar numbers of lymph nodes retrieved, similar TNM classifications, and a comparable incidence of postoperative complications. The 2 groups were also similar in local recurrence rate, distant metastasis rate, and short-term survival rate.ConclusionThe results demonstrate that the HAL-CME procedure is a safe, valid, and feasible surgical method for right hemicolon cancers.

Laparoscopic versus open complete mesocolic excision with central vascular ligation in right colon cancer

“…These results were in agreement with those reported by Sheng et al, 2017 who stated that, the open and laparoscopic techniques were the same in age, sex distribution, tumor localization, and potential comorbidities (all p>0.05) 11 . However, Vendramini et al, 2012 observed that, there was a statistical significant difference (p=0.049) with a higher prevalence of open procedure between the patients aged 60 or over 12 .…”

“…These results were close to the study of Sheng et al, 2017 who demonstrated that, the median follow up duration of the laparoscopic and open groups was 20.1±4.6 months. 11…”

Ranka asistuojamoji laparoskopinė gaubtinės ir tiesiosios žarnos chirurgija: vieno centro 473 ligonių patirtis

“…With experience gained, general complication rate in our centre is also decreasing [1,4,14]. While our length of stay data compare favourably with other reports [1,6,24].…”

Hand-Assisted Laparoscopic Surgery for the Cancer of the Left Colon and Rectum - An Ideal Option of Minimally Invasive Surgery? Single Centre Experience With 459 Cases

“…With experience gained, general complication rate in our centre is also decreasing [1,4,14]. While our length of stay data compare favourably with other reports [1,6,24]. There is still arguments against HALS, mainly because of incision length [5,17] or uncertainty about long-term results such as development of adhesive small bowel obstruction or ventral hernias В недавних исследованиях было подчёркнуто влияние количества лимфатических узлов в препарате на онкологические результаты.…”

“…По мере набора опыта снизилась общая частота осложнений в нашем центре [1,4,14]. Следует отметить, что в нашем исследовании длительность послеоперационного пребывания пациента в стационаре выгодно отличалась от результатов, опубликованных в других работах [1,6,24]. До сих пор существуют доводы против HALS, главным образом, из-за длины кожного разреза [5,17] или неопределенности в отношении отдалённых результатов, таких как развитие острой спаечной кишечной непроходимости и послеоперационной вентральной грыжи [25].…”