Outcomes of laparoscopic assisted versus open complete mesocolic excision for right sided colon cancer

Abstract

Background: Complete mesocolic excision (CME) as a standard surgery for left sided colon cancer is proven however there is a great debate and deal of discussion if the extra effort needed for it in right sided colon cancer worth the gain that is achieved. We aimed in our study to assess the outcome of CME with central vascular ligation for treatment of right sided colon cancer performed either laparoscopic (lap.) assisted or by open technique.Methods: This was a prospective randomized study on sixty patients who were presented with right sided colonic cancer. Patients were divided into two groups. Group (A) open one and group (B) lap. assisted group.Results: Both groups were comparable regarding demographic data, although operative time was significantly shorter in open group (p>0.001). Lap. assisted group achieved a significant difference as regards to blood loss, incision length, duration of hospital stay, resume of oral feeding, tumor to high vascular tie as well as higher number of harvested lymph nodes with no difference in recurrence rate and overall survival rate over a period of 3 years follow up.Conclusions: The principles underlying CME are anatomical and logical as it entails return back to embryology, and the results published points to the improved survival and decreased local recurrence particularly when it is performed in the proper mesocolic plane, using of laparoscopy may help in that due to better visualization of planes thus the gain of CME even in right sided colon cancer may exceed the pain in hand skilled colorectal lap. surgeons.

A global systematic review and meta-analysis on laparoscopic vs open right hemicolectomy with complete mesocolic excision

“…After screening of titles and abstracts, 36 studies were analysed in full text, with 12 studies excluded as reported in SDC1, leaving 23 studies matching the inclusion criteria for meta-analysis [ 13 – 47 ], one PhD thesis by El Nakeeb (not published) [ 13 ]. Of these, two references [ 15 , 16 ] report the same data as well as the PhD thesis [ 13 ]. In addition, we found one ongoing study (registered in ClinicalTrials.gov as NCT03826446) [ 48 ].…”

“…Altogether, the 21 studies included provided data on 5038 patients (Table 1 ). The included studies were published between 2010 and 2020, with participants enrolled between 2000 [ 19 , 34 ] and 2019 [ 13 , 15 ] (Table 1 ).…”

“…Among the examined studies, patients with stage IV disease were excluded, except for one [ 18 ]. The other studies include stages I, II and III, but two [ 14 , 25 ] only included stage III cancers and two [ 22 , 26 ] only included stages II and III; in addition, five studies [ 15 , 28 – 30 , 32 ] do not indicate the TNM stage.…”

“…There were one RCT, performed at Menoufia University (Egypt) [15,16] and 20 CCTs [14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Sixteen studies were performed in Asia (4601 patients, 91.3%), including 13 from China (2158 patients), 2 from South Korea (2419 patients) and 1 from Bangladesh (24 patients).…”

“…The overall number of harvested lymph nodes was reported in 3876 patients (19 studies) [14,15,[17][18][19][20][21][24][25][26][27][28][29][30][31][32][33][34][35]. The number of nodes was higher in the laparoscopic group, but the difference was not statistically significant (MD 0.68, − 0.41-1.76, P = 0.22, I 2 = 90%).…”