Clinical outcome of laparoscopic and open colectomy for right colonic carcinoma

Abstract

Laparoscopic colorectal surgery has gained widespread acceptance. While many studies have compared laparoscopic and open left-sided resections, there is limited literature on right colonic resections. We aimed to analyse the short-term outcome of laparoscopic (LRH) and open right hemicolectomy (ORH) in our unit. Consecutive patients undergoing elective right hemicolectomies over a period of 28 months were included in the study. No selection criteria were used to allocate the surgical approach. Study parameters included surgical technique, demographic details, ASA grade, body mass index (BMI), length of hospital stay (LOS), post-operative mortality and morbidity, readmission rate and histopathological data. A total of 164 patients underwent right hemicolectomies during the study period (LRH: 89, ORH: 75). Both groups were comparable in age, sex, BMI, ASA grade, tumour stage and lymph node harvest. Four patients (4.5%) in the laparoscopic group required conversion to open surgery. In resections with curative intent, microscopic margins were positive in two patients (3%) in the ORH group compared with one (1%) in the LRH group. Seven ORH patients had an adverse post-operative outcome (three anastomotic leaks, four deaths); there were no deaths/immediate complications in the LRH group (p<0.05). The median LOS for LRH patients (4 days, range: 2-21 days) was significantly shorter than for ORH patients (8 days, range: 3-38 days) (p<0.0001, Mann-Whitney U test). By day 5, 77% of LRH patients were discharged compared with only 21% of patients in the ORH group. There were two readmissions (2.7%) in the ORH group and nine (10.1%) in the LRH group. Our findings demonstrate advantages in favour of LRH in terms of a shorter hospital stay and reduced post-operative major complications. LRH is safe and should therefore be available to all patients requiring colonic resection.