Laparoscopic versus open transverse‐incision right hemicolectomy: a retrospective comparison study

Abstract

Background The optimal surgical approach to right colon cancer is still under debate. The aim of the present study was to compare the short‐ and long‐term outcomes of laparoscopic and transverse‐incision open approaches to right hemicolectomy for colon cancer. Methods Data on 99 adult patients with right‐side colon cancer undergoing either laparoscopic or open transverse‐incision right hemicolectomy at two different university hospitals, between January 2013 and December 2016, were retrospectively reviewed. Data concerning patients’ characteristics, operative details and post‐operative recovery were retrieved from prospective databases and analysed. Results Forty‐nine subjects were operated on laparoscopically, while 50 through an open transverse incision. Operating time was significantly longer in the laparoscopic group compared with the open group (182 versus 105 min; P < 0.01). Patients treated laparoscopically had a shorter time to first bowel movement, while time to resume a normal diet and post‐operative length of hospital stay were comparable in between groups. The median number of lymph nodes harvested was higher in the laparoscopic group (25.6 versus 18.6; P < 0.01), but no significant difference in overall survival between groups was detected. At long‐term follow‐up, the incidence of incisional hernia was higher in the laparoscopic group as compared to the open group (24.5% versus 0%; P = 0.0002). Conclusion Our results show that laparoscopic right hemicolectomy when compared to the transverse‐incision open procedure may guarantee the same oncological radicality, but short‐term functional benefits are still unclear. Randomized control studies are warranted to better clarify the comparison of these two approaches for right‐sided colon cancers.

Current status and trend of laparoscopic right hemicolectomy for colon cancer

“…Even for advanced colon cancer with clinical stage II/III, better short‐term outcomes and similar overall survival in laparoscopic surgery compared with open surgery with a low conversion rate of 5.4% were demonstrated by the Japan Clinical Oncology Group (JCOG) 0404 trial 9,10 . When focusing on LRH, similar outcomes in favor of laparoscopic surgery were demonstrated by recent studies 11–16 . In 2015, Arezzo et al reported that the mortality and morbidity rate was lower in the laparoscopic group than the open group (1.2% vs 3.4%; P = .031; and 16.8% vs 24.2%; P = .007, respectively) based on their systematic review on 3049 patients 11 .…”

“…9,10 When focusing on LRH, similar outcomes in favor of laparoscopic surgery were demonstrated by recent studies. [11][12][13][14][15][16] In 2015, Arezzo et al reported that the mortality and morbidity rate was lower in the laparoscopic group than the open group (1.2% vs 3.4%; P = .031; and 16.8% vs 24.2%; P = .007, respectively) based on their systematic review on 3049 patients. 11 Moreover, Rausa et al reported in their meta-analysis a significantly higher risk of overall complication and reoperation in the open surgery group compared to the total laparoscopic surgery group.…”

Comparing extracorporeal, semi-extracorporeal, and intracorporeal anastomosis in laparoscopic right hemicolectomy: introducing a bridging technique for colorectal surgeons

“…Many studies have reported higher rates of incisional hernia in the EA group [ 25 26 ]. According to Feo et al [ 25 ], all EA specimens were extracted through the extension of the umbilicus wound, while the IA specimen extraction site varied from umbilicus, right lower quadrant trocar site, or Pfannenstiel incision. Hellan et al [ 26 ] reported the incidence of incisional hernia in IA only in patients whose specimen was not removed through a Pfannenstiel incision.…”

An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure

“…Six articles dealing with off-midline incisions were retrieved accounting for 515 patients: two were RCT [21,29] (377 patients); four were retrospective studies [35,53,88,100] (138 patients). The pooled proportion of incisional hernia in RCT was 0.02 (95% CI 0.00-0.07), I 2 52% and in retrospective studies 0.03 (95% CI 0.00-0.32) I 2 87%, without statistical differences.…”