Tunnel versus medial approach in laparoscopic radical right hemicolectomy for right colon cancer: a retrospective cohort study

Abstract

Purpose This study aimed to explore the feasibility and safety of the tunnel approach in laparoscopic radical right hemicolectomy for colon cancer. Methods From July 2016 to October 2018, a total of 106 consecutive patients with colon cancer who underwent laparoscopic radical right hemicolectomy at the Affiliated Cancer Hospital of Zhengzhou University were enrolled. The patients were stratified into either a tunnel approach (TA) (n = 56) group or traditional medial approach (MA) (n = 50) group according to the surgical technique performed. The baseline demographics, perioperative outcomes and oncologic outcomes were compared between the two groups. Results The baseline characteristics did not differ between groups. The TA group had significantly less blood loss [20.0 (10.0–40.0) vs. 100 (100.0–150.0) ml, p < 0.001] and a shorter operation time [128.4 ± 16.7 vs. 145.6 ± 20.3 min, p < 0.001] than the MA group. The time to first flatus and postoperative hospital stay were similar [3.0 (2.0–4.0) vs. 3.0 (3–4.0) days, p = 0.329; 10.4 ± 2.6 vs. 10.7 ± 3.0 days, p = 0.506] between the two groups. The conversion to laparotomy and complication rates were similar between groups (0 vs. 6.0%, p = 0.203; 14.3% vs. 18.0%, p = 0.603, respectively). No treatment-related deaths occurred in either group. The TA group did not have significantly better survival outcomes than the MA group (p = 0.372). Conclusions The TA seems to allow for more favourable results in terms of blood loss and operative time than the MA, with similar results regarding time to first flatus, hospital stay, postoperative complication rate, conversion rate and oncologic outcomes; moreover, the TA is easier for beginners to master.

The safety and short-term effect of mixed approach in laparoscopic right hemicolectomy for right colon cancer compared with middle approach: a retrospective study

“…Currently, it is considered that factors related to the number of lymph nodes detected during colorectal cancer surgery, including tumor site size, length of surgical specimens, T-type classification, depth of invasion, and AJCC/UICC staging. They are predictive factors of the number of lymph nodes in colorectal cancer surgery [ 8 , 10 , 19 ]. However, several studies have indicated that the surgical approach is not correlated with the number of lymph nodes detected.…”

“…It is recognized that the middle approach is a safe and effective way to achieve CME and D3 lymph node dissection currently [ 7 ]. However, the operation takes a long time, and it is easy to cause more intraoperative bleeding [ 8 ]. In recent years, with the development of surgical technology, surgical approaches have been continuously optimized.…”

Development and validation of a preoperative nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer: a retrospective analysis

“…Thus, laparoscopic right hemicolectomy with CME is widely accepted for colon cancer. However, owing to the complexity of laparoscopic right hemicolectomy, difficult cases have a notable incidence of intraoperative complications (18.0%) and of conversion from laparoscopy to the open approach (6%) 4 . Although conversion and intraoperative complications should not be considered surgical failures, these factors influence the postoperative recovery.…”