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

Xijie Zhang,Chenyu Liu,Pengfei Ma,Junli Zhang,Sen Li,Yuzhou Zhao,Yanghui Cao,Zhi Li

doi:10.1186/s12893-022-01491-5

Abstract

PurposeThis study aimed to explore the feasibility and safety of the tunnel approach in laparoscopic radical right hemicolectomy for colon cancer.MethodsFrom 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.ResultsThe 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).ConclusionsThe 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.

Highlights

Laparoscopic right hemicolectomy was first recommended by Jacobs et al [1] in the 1990s, and laparoscopic radical right hemicolectomy has become the standard procedure for the treatment of right-sided colon cancer
The medial approach (MA) in laparoscopic right hemicolectomy is a demanding procedure with a steep learning curve and has a high rate of conversion to laparotomy, mainly because of anatomic complexities and high level of variation in the right colonic vessels [14, 15]
This study aimed to explore the surgical feasibility and safety of the tunnel approach (TA) in comparison to the MA in laparoscopic right hemicolectomy

Summary

Introduction

Multiple studies have shown that the various approaches achieve different advantages for laparoscopic right hemicolectomy. The MA in laparoscopic right hemicolectomy is a demanding procedure with a steep learning curve and has a high rate of conversion to laparotomy, mainly because of anatomic complexities and high level of variation in the right colonic vessels [14, 15]. In reference to the different aforementioned surgical approaches, we improved the caudal approach explored the tunnel approach (TA) to perform CME based on the idea of an “easier surgery”. Previous studies have shown that TA has achieved satisfactory clinical results [16]. This study aimed to explore the surgical feasibility and safety of the TA in comparison to the MA in laparoscopic right hemicolectomy

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Results

Conclusion