Right versus left laparoscopic colectomy for colon cancer: does side make any difference?

Campana, Juan Pablo; Pellegrini, Pablo Ariel; Rossi, Gustavo; Quintana, Guillermo Ojea; Mentz, Ricardo; Vaccaro, Carlos

doi:10.1007/s00384-017-2776-x

Cited by 36 publications

(33 citation statements)

References 22 publications

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“…Nevertheless, as in previous studies, ERAS patients in our study showed a reduction in hospital days without any difference in complications, even with early resumption of diet. This finding is particularly interesting considering that the ERAS group had significantly more patients undergoing surgery for right-side colon cancer, which is known to be prone to postoperative ileus 16,17 . There was a difference in the Conventional-SILS and Conventional-Multi groups, in that they resumed diet only after gas passage compared to the ERAS group.…”

Section: Discussionmentioning

confidence: 88%

Comparison of the effects of an ERAS program and a single-port laparoscopic surgery on postoperative outcomes of colon cancer patients

Kim

Lee

et al. 2019

Sci Rep

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Advancement of the surgical modality and perioperative care are the two main dimensions for the modern improvement of surgical outcome. The purpose of this study was to compare the effectiveness of the two by using the data from the single-port laparoscopic surgery and the early recovery after surgery (ERAS) program. Patients who underwent elective surgery for primary adenocarcinoma of the colon were divided into three groups and compared: ERAS (multi-port laparoscopic surgery with ERAS perioperative care), Conventional-SILS (single-port surgery with conventional perioperative care), or Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care). Ninety-one, 83, and 96 patients were registered, respectively. There were no differences among the three groups in baseline characteristics except pathological stage and operation site in colon. Although the ERAS group started a soft diet earlier and had earlier discharge, there were no differences in intra- and post-operative morbidity rate, readmission rate, or reoperation rate. The ERAS perioperative care was a significant factor for reducing length of hospital stay in the multivariate analysis, while single-port surgery was not. In modern laparoscopic colon cancer treatment, a systemic approach such as the ERAS program appears to be more effective than a technical approach for significantly improving short-term surgical outcomes.

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Section: Discussionmentioning

confidence: 88%

Comparison of the effects of an ERAS program and a single-port laparoscopic surgery on postoperative outcomes of colon cancer patients

Kim

Lee

et al. 2019

Sci Rep

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“…Campana et al . described a POI rate of 11% (an increase of over four‐fold) after right‐sided laparoscopic cancer resections, despite shorter operative time, in a high‐volume institution. In their study, all ileocolic anastomoses were hand‐sewn, providing a potential explanation for this difference, according to the authors.…”

Section: Discussionmentioning

confidence: 99%

“…A UK multicentre snapshot observational study of 204 colectomies hypothesized that differences in vagal innervation or 'pacemaker' regions may be one explanation for this difference [15]. Campana et al [3] described a POI rate of 11% (an increase of over four-fold) after right-sided laparoscopic cancer resections, despite shorter operative time, in a high-volume institution. In their study, all ileocolic anastomoses were hand-sewn, providing a potential explanation for this difference, according to the authors.…”

Section: Discussionmentioning

confidence: 99%

“…Most surgeons would probably intuitively label right‐sided resections as less technically demanding than left‐sided colectomies, because of better exposure and intraperitoneal location of the anastomosis, especially when splenic flexure mobilization or rectal mobilization is warranted . However, some recent studies described a tendency towards slower recovery after right‐sided procedures, which was partly explained by increased postoperative ileus (POI) rates . The reasons for delayed recovery after right‐sided resections are as yet undetermined.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of recovery and outcome after left and right colectomy

et al. 2019

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Aim The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. Method Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30‐day complications, were compared between left‐sided and right‐sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). Results In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left‐sided resections (> 30 kg/m2: 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27–5.46) and fluid overload (OR = 2.02, 95% CI: 1.06–3.82) were independent risk factors for POI. Conclusion Despite equal ERP compliance, postoperative ileus was higher after right‐sided colectomies. This finding was associated with Crohn's disease and fluid overload.

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“…As a result, the type of surgery was not associated with POI ( P = 0.242). Although one retrospective study suggested that right-sided laparoscopic colectomy is associated with a four-fold higher risk of POI than a left-sided laparoscopic colectomy [ 18 ], another study failed to demonstrate a relationship between the risk of POI and the anatomical location of the surgery [ 19 ]. Thus, considering our results together, the impact of the anatomical location of the surgery on the risk of POI may not be substantial.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery

Choi

Kim

et al. 2018

PLoS ONE

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Postoperative ileus (POI) is an important factor prolonging the length of hospital stay following colorectal surgery. We retrospectively explored whether there is a clinically relevant association between intraoperative hypothermia and POI in patients who underwent laparoscopic colorectal surgery for malignancy within the setting of an enhanced recovery after surgery (ERAS) program between April 2016 and January 2017 at our institution. In total, 637 patients were analyzed, of whom 122 (19.2%) developed clinically and radiologically diagnosed POI. Overall, 530 (83.2%) patients experienced intraoperative hypothermia. Although the mean lowest core temperature was lower in patients with POI than those without POI (35.3 ± 0.5°C vs. 35.5 ± 0.5°C, P = 0.004), the independence of intraoperative hypothermia was not confirmed based on multivariate logistic regression analysis. In addition to three variables (high age-adjusted Charlson comorbidity index score, long duration of surgery, high maximum pain score during the first 3 days postoperatively), cumulative dose of rescue opioids used during the first 3 days postoperatively was identified as an independent risk factor of POI (odds ratio = 1.027 for each 1-morphine equivalent [mg] increase, 95% confidence interval = 1.014–1.040, P <0.001). Patients with hypothermia showed significant delays in both progression to a soft diet and discharge from hospital. In conclusion, intraoperative hypothermia was not independently associated with POI within an ERAS pathway, in which items other than thermal measures might offset its negative impact on POI. However, as it was associated with delayed discharge from the hospital, intraoperative maintenance of normothermia is still needed.

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Right versus left laparoscopic colectomy for colon cancer: does side make any difference?

Abstract: RLC for colon cancer was independently associated with a shorter operative time, an increased risk of ileus, and a longer hospital stay than left laparoscopic colectomy in high-volume centers.

Cited by 36 publications

References 22 publications

Comparison of the effects of an ERAS program and a single-port laparoscopic surgery on postoperative outcomes of colon cancer patients

Comparison of the effects of an ERAS program and a single-port laparoscopic surgery on postoperative outcomes of colon cancer patients

Comparison of recovery and outcome after left and right colectomy

A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery

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