Comparative Study of Short Term Outcome of Laparoscopically Assisted versus Totally Laparoscopic Right Colectomy for Right Sid- ed Cancer Colon

Abstract

Introduction: Colorectal cancer (CRC) is the third most common cancer in men and second in women worldwide. It is one of the leading causes of cancer death all over the world. Right-sided colon cancer represents approximately 15% of all cases of CRC. This study was designed to compare the short-term surgical outcomes of laparoscopic-assisted right colectomy (LARC) and totally laparoscopic right colectomy (TLRC) for right sided cancer colon. Aim of the study: This study was designed to show whether there was any advantage or disadvantage between LARC and TLRC for right sided cancer colon as regard the short term surgical outcomes. Patients and methods: A consecutive series of 40 patients underwent elective surgery for right-sided colon cancer from April 2014 to October 2015 in Ain Shams University hospitals, Cairo, Egypt and in Al Hamadi hospital, Riyadh, Saudi Arabia. Patients were treated by laparoscopic right colectomy through a medial to lateral approach. In 20 patients a TLRC was performed and in 20 patients LARC was performed. Perioperative care plan, operative steps and surgical instrumentations were standardized. Data on the patients’ demographics, disease features, operative details and follow up were recorded and analyzed. Results: There was no significant difference in term of demographic characteristics, co-morbidities, site of tumor and stage of disease between the two groups. There were 3 cases of conversion to laparotomy. Median operative time (179.7±16.95 minutes versus 179.85±17.16 minutes; not significant (NS)) and estimated blood loss (67±16.73 ml versus 65.25±16.42 ml; NS) were statistically not significant in both groups. Timing of first defecation (2.75±0.79 days versus 2.6±0.75 days; NS) and length of hospital stay (4.85±0.81 days versus 4.7±1.8 days; NS) were statistically not significant. A significantly longer length of skin incision characterized LARC group compared with TLRC group (6.3±0.99 cm versus 5.4±0.76; P 0.0016). Both groups achieved an adequate number of lymph nodes harvested (15.6±1.19 versus 16.8±1.5 nodes; P 0.008) and oncological resection of the tumor (proximal margin 9.1±3.22 cm versus 9.55±2.8 cm; NS with distal margin 11.2±2.35cm versus 12.4 ±2.3cm; NS). Post-operative complications were statistically comparable in both groups. No readmission within 30 days of discharge was observed. Conclusions: Meanwhile most surgeons prefer LARC because it’s less technically demanding than TLRC. Both are feasible and safe techniques, with comparable results as regard operative time, preservation of oncologic principles and post operative short-term outcome. Yet, TLRC is superior regarding specimen extraction in both the length and site of skin incision required for specimen extraction.