The Role of Hand-Assisted Laparoscopic Surgery in a Right Hemicolectomy for Right-Sided Colon Cancer

Abstract

PurposeThe purpose of this study is to evaluate the perioperative and long-term oncologic outcomes of hand-assisted laparoscopic surgery (HALS) and standard laparoscopic surgery (SLS) and assess the role of HALS in the management of right-sided colon cancer.MethodsThe study group included 53 patients who underwent HALS and 45 patients who underwent SLS for right-sided colon cancer between April 2002 and December 2008.ResultsThe patients in each group were similar in age, American Society of Anesthesiologist (ASA) score, body mass index, and history of previous abdominal surgeries. Eight patients in the HALS group and no patient in the SLS group exhibited signs of tumor invasion into adjacent structures. No differences were noted in the time to return of normal bowel function, time to toleration of diet, lengths of hospital stay and narcotic usage, and rate of postoperative complications. The median incision length was longer in the HALS group (HALS: 7.0 cm vs. SLS: 4.8 cm, P < 0.001). The HALS group had a significantly higher pathologic TNM stage and significantly larger tumor size (HALS: 6.0 cm vs. SLS: 3.3 cm, P < 0.001). The 5-year overall, disease-free, and cancer-specific survival rates of the HALS and the SLS groups were 87.3%, 75.2%, and 93.9% and 86.4%, 78.0%, and 90.7%, respectively (P = 0.826, P = 0.574, and P = 0.826).ConclusionAlthough patients in the HALS group had more advanced disease and underwent more complex procedures than those in the SLS group, the short-term benefits and the oncologic outcomes between the two groups were comparable. HALS can, therefore, be considered an alternative to SLS for bulky and fixed right-sided colon cancer.

Hand-assisted laparoscopic surgery versus laparoscopic right colectomy: a meta-analysis

“…A total of 88 studies were retrieved by the primary search, and five clinical studies were eligible for the meta-analysis eventually [ 19 – 23 ], involving 438 patients of whom 202 in HALS group and 236 in LRC group. Figure 1 shows the detailed process of the studies selection.…”

“…Figure 1 shows the detailed process of the studies selection. Among the included trials, three trials [ 19 , 20 , 22 ] compared malignant cases between HALS and LRC, and two trials [ 21 , 23 ] compared malignant and benign cases, whose sample size ranged from 58 to 127. The study characteristics and baseline data of patients are listed in Table 1 .…”

“…The RCT [ 20 ] was of high risk of bias, and the four non-RCTs [ 19 , 21 – 23 ] achieved NOS score of 7 or more, which showed the included studies were high quality. The quality assessment is detailed in Table 2 .…”

“…LRC makes an extra small incision to extract the specimen at the end of operation. Both the port site (in HALS) and the extraction site (in LRC) are potential sites for future ventral hernia, and Bae et al [ 19 ] showed there was no statistical difference between HALS and LRC.…”

Need for Reappraisal of Hand-Assisted Laparoscopic Surgery for Colorectal Diseases in the Era of Desiring Small Incisions

“…HALS surgeons easily understand that HALS plays a key role as a type of surgery between SLS and open surgery. In a study [ 4 ] comparing 53 patients who underwent HALS and 45 patients who underwent SLS for right-sided colon cancer, the HALS group had significantly larger tumors (HALS: 6.0 cm vs. SLS: 3.3 cm, P < 0.001) and significantly higher TNM stage (HALS vs. SLS: stage 0, n = 2 vs. n = 11; I, n = 5 vs. n = 15; II, n = 28 vs. n = 9; III, n = 18 vs. n = 10, P < 0.001). However, no significant differences in the 5-year overall, disease-free, and cancer-specific survival rates between the HALS and the SLS groups were reported.…”