Laparoscopic versus Open Complete Mesocolic Excision for Right Colon Cancer

Abstract

Background and Objectives. The use of complete mesocolic excision (CME) technique seems to be gaining popularity in the management of cancer colon. We aim to compare the laparoscopic approach for CME with the open approach in right colon cancer treatment with regard to the feasibility, safety, and perioperative and oncologic outcomes. Patients and Methods. A prospective study which included all patients that underwent radical right hemicolectomy for pathologic confirmed stage II or stage III tumor with CME at South Egypt Cancer Institute, Assiut University, from January 2012 to December 2019. Patients were grouped according to the surgical approach into the laparoscopic colectomy (LCME) group (n = 48) or open colectomy (OCME) group (n = 48). Results. The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P = 0.010 ). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) ( P = 0.252 ). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance ( P value = 0.266). Conclusions. In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.

The relationship between preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score and right colon cancer surgery outcomes: a retrospective cohort study

“…Our operation times for laparoscopic right hemicolectomy are consistent with current surgical standards, averaging 204.57 minutes, which is consistent with the 201.31 minutes reported by Zedan et al [22] . However, our open surgeries averaged 183.10 minutes, exceeding the durations reported by Zedan et al [22] at 152.04 minutes, Chen et al [21] at 123/118.5 minutes, and Han et al [17] at 110/133 minutes. These extended times in open procedures could reflect the complexities involved in managing a geriatric and comorbid patient cohort.…”

Complete mesocolic excision for right hemicolectomy: an updated systematic review and meta-analysis

“…These articles were recent; 15 were published in the last 5 years [ 15 – 29 ], and none before 2013. Data from three studies were prospectively collected [ 17 , 24 , 28 ], two were retrospective case–control studies [ 15 , 16 ], 18 were retrospective cohort studies [ 18 , 19 , 21 – 23 , 25 – 27 , 29 – 38 ], and one was a randomised controlled trial [ 20 ]. Thirteen compared surgical techniques for CME [ 25 – 29 , 31 – 38 ].…”

The importance of laparoscopic surgery for early postoperative course in patients with colorectal carcinoma

“…Numerous studies have been done and some are ongoing, examining whether laparoscopic surgery has grown open surgery and is it able to fulfil adequately oncological radicality, which is essentially of paramount importance. [6,7,8].…”