Right Hemicolectomy and Appendix

Abstract

Colorectal Cancer (CRC) is the second most common cause of cancer death in the USA. The lifetime risk for colon cancer in America is 1 in 17. Surveillance Epidemiology and End Results (SEER) program data estimates that the incidence of colon cancer has decreased by 20%, whereas the mortality has also decreased by approximately 30% in the last 25 years. Nevertheless, SEER data estimates that CRC constitutes approximately 10.6% of all new cancer cases and is responsible for approximately 10% of all cancer deaths in the USA. Surgical R0 resection is the cornerstone for treatment of right-sided colon cancer and was first described in 1888 by Lubarsh. Probably, one of the most important advances in the last 2 decades was the development of laparoscopic surgery. In fact, laparoscopy is emerging as the preferred approach for different types of colectomies in benign and malignant disease processes. The evidence-based support for oncologic equivalency of laparoscopic-assisted colectomy (LAC) when compared with open colectomy (OC) is now available. Oncologic concerns raised from high wound recurrence rates prompted a series of multi-institutional randomized trials to test the hypothesis that disease-free and overall survival are equivalent, regardless of whether patients receive LAC or OC. Our single institution randomized controlled trial of LAC versus OC with a median follow-up of 43 months and 219 patients (111 LAC group, 108 OC group), identified a cancer-related survival advantage in patients with stage III CRC treated with laparoscopy. In this chapter, we report our own data and data from the literature, as they are important to understand and judge oncological accuracy of laparoscopic colorectal surgery. We provide insight into state-of-the-art workup and give the reader a step by step operative guide as well.