Abstract
Background: Laparoscopic right colectomy (LRHC) is a procedure which has been getting more popular compared to traditional open right colectomy (ORHC) over the last three decades. This study compares the post-operative outcomes in laparoscopic and open right colectomy for colon cancer.
Patients and Methods: This is a retrospective study of right colectomy at a single institution from January 2018 to December 2021. The factors that were studied included postoperative HDU admission, the incidence of post-operative ileus (POI) and the length of hospital stay.
Results: During the study period, 161 patients underwent right hemicolectomy. Sixty-seven (42%) underwent LRHC, 73 (45%) ORHC, and 21 (13%) laparoscopic converted to open procedure. The overall incidence of POI was 56 (35%), 14 (21%) among the LRHC and 28 (38%) among the ORHC group (p=0.024). The length of hospital stay was 7.1 (±4.8) days after the laparoscopic procedure compared to 8.7 (±4.4) in the open group (p=0.048). Forty-two patients out of 161 (26%) needed post-operative HDU admissions; out of these 11 (16%) were in the laparoscopic group and 29 (40%) among the open group (p=0.023).
Conclusion: Post-operative recovery was significantly quicker among the laparoscopic right hemicolectomy group incomparison to the open right hemicolectomy group.
References
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991;1(3):144-150.
Künzli BM, Friess H, Shrikhande SV. Is laparoscopic colorectal cancer surgery equal to open surgery? An evidence based perspective. World J Gastrointest Surg 2010;2(4):101-108. Available from: https://doi.org/10.4240/wjgs.v2.i4.101
Chung CC, Ha JP, Tsang WW, Li MK. Laparoscopic-assisted total mesorectal excision and colonic J pouch reconstruction in the treatment of rectal cancer. Surg Endosc. 2001;15(10):1098-1101. Available from: https://doi.org/10.1007/s00464-001-9000-2
Yamamoto S, Watanabe M, Hasegawa H, Kitajima M. Prospective evaluation of laparoscopic surgery for rectosigmoidal and rectal carcinoma. Dis Colon Rectum. 2002;45(12):1648-1654. Available from: https://doi.org/10.1007/s10350-004-7253-2
Morino M, Parini U, Giraudo G, et al. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg. 2003;237(3):335–342. Available from: https://doi.org/10.1097/01.SLA.0000055270.48242.D2
Benz S, Tam Y, Tannapfel A, Stricker I. The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc. 2016;30(5):1930–7. Available from: https://doi.org/10.1007/s00464-015-4417-1
Haas EM, Pedraza R, Nieto J, Malave V. Single-incision laparoscopic right hemicolectomy: inferior-to-superior approach with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech. 2014;24(6):e226–7. Available from: https://doi.org/10.1097/SLE.0b013e3182937bf6
Krouchev R, Tamana S, Nguyen N, Yorke E, Harris D, Sampath S. Total intracorporeal anastomosis for right hemicolectomy: experience from a Canadian center. Am J Surg. 2018;215(5):905–8. Available from: https://doi.org/10.1016/j.amjsurg.2018.02.013
Tong DK, Law WL. Laparoscopic versus open right hemicolectomy for carcinoma of the colon. JSLS. 2007;11(1):76-80.
Di Lascia A, Tartaglia N, Petruzzelli F, et al. Right hemicolectomy: laparoscopic versus robotic approach. Ann Ital Chir 2020;91:478-485.
Stavrou E, Tzanakis N, Spartalis E, et al. Comparison of post-operative and oncologic outcomes in laparoscopic and open right colectomy for colon cancer: a 5-year experience. In Vivo. 2022;36(2):969-972. Available from: https://doi.org/10.21873/invivo.12788
Wind J, Polle SW, Fung Kon Jin PH, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006;93(7):800-9. Available from: https://doi.org/10.1002/bjs.5384
Sammour T, Zargar-Shoshtari K, Bhat A, et al. A program of Enhanced Recovery After Surgery (ERAS) is a cost-effective intervention in elective colonic surgery. NZMJ. 2010;123(1319):61-70.
Gouvas N, Tan E, Windsor A, et al. Fast-track vs standard care in colorectal surgery: A meta-analysis update. Int J Colorectal Dis 2009;24(10):1119-31. Available from: https://doi.org/10.1007/s00384-009-0703-5
Tjandra JJ, Chan MK. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 2006;8(5):375. Available from: https://doi.org/10.1111/j.1463-1318.2006.00974.x
Young-Fadok TM, Fanelli RD, Price RR, et al. Laparoscopic resection of curable colon and rectal cancer: An evidence-based review. Surg Endosc 2007;21(7):1063. Available from: https://doi.org/10.1007/s00464-006-9172-x
Veldkamp R, Kuhry E, Hop WCJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–84. Available from: https://doi.org/10.1016/S1470-2045(05)70221-7
Nelson H, Sargent DJ, Wieand HS, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050–9. Available from: https://doi.org/10.1056/NEJMoa032651
Bauer AJ, Boeckxstaens GE. Mechanisms of postoperative ileus. Neurogastroenterol Motil. 2004;16(Suppl 2):54–60. Available from: https://doi.org/10.1111/j.1743-3150.2004.00558.x
Tan WS, Chew MH, Ooi BS, et al. Laparoscopic versus open right hemicolectomy: a comparison of short-term outcomes. Int J Colorectal Dis. 2009;24(11):1333-9. Available from: https://doi.org/10.1007/s00384-009-0743-x
Matsuda T, Endo H, Inomata M, et al. Clinical outcome of laparoscopic vs open right hemicolectomy for colon cancer: A propensity score matching analysis of the Japanese National Clinical Database. Ann Gastroenterol Surg. 2020;4(6):693-700. Available from: https://doi.org/10.1002/ags3.12381
Neyens R, Jackson KC 2nd. Novel opioid antagonists for opioid induced bowel dysfunction and postoperative ileus. J Pain Palliat Care Pharmacother. 2007;21(2):27-33.
Khan JS, Hemandas AK, Flashman KG, Senapati A, O’Leary D, Parvaiz A. Clinical outcome of laparoscopic and open colectomy for right colonic carcinoma. Ann R Coll Surg Engl. 2011;93(8):603-7. Available from: https://doi.org/10.1308/147870811X13137608455299
Lee CZ, Kao LT, Lin HC, Wei PL. Comparison of clinical outcome between laparoscopic and open right hemicolectomy: a nationwide study. World J Surg Oncol. 2015;13:250. Available from: https://doi.org/10.1186/s12957-015-0666-7
Chaouch MA, Dougaz MW, Mesbehi M, et al. A meta-analysis comparing hand-assisted laparoscopic right hemicolectomy and open right hemicolectomy for right-sided colon cancer. World J Surg Oncol.2020;18(1):91. Available from: https://doi.org/10.1186/s12957-020-01869-w