Laparoscopic vs open complete mesocolic excision with central vascular ligation for right-sided colon cancer

Abstract

Complete mesocolic excision (CME) is being performed more frequently and has recently become an established oncologic surgical method for right hemicolectomy. Despite its advantages, such as its association with early mobilization, a short hospital stay, early bowel movement, mild postoperative pain, and good cosmesis, CME is technically demanding and carries the risk of severe complications. This study aims to compare the clinical, pathological, and oncological results of open and laparoscopic right hemicolectomy with CME.The data of 76 patients who underwent right hemicolectomy with CME and high vascular ligation were reviewed retrospectively. The patients were divided into 2 groups according to whether the open or laparoscopic technique was used.Thirty-two patients underwent open right hemicolectomy, and 44 patients underwent laparoscopic right hemicolectomy. The 2 groups were similar in age, sex, American Society of Anesthesiologists class, abdominal surgical history, tumor localization, and operation time. No significant differences were found regarding the specimen length, tumor size, harvested lymph nodes, number of metastatic lymph nodes, or tumor grade. According to the Clavien-Dindo classification system, the laparoscopic group had significantly fewer complications than did the open group (11.4% vs 31.2%; P = .04). The open group had a longer postoperative hospital stay than did the laparoscopic hemicolectomy group (9.9 ± 4.7 vs 7.2 ± 3.1 days; P = .002). In addition, the groups were similar with respect to disease-free survival (P = .14) and overall survival (P = .06).The data in this study demonstrated that no differences exist between the open and laparoscopic techniques concerning pathological and oncological results. However, significantly fewer complications and a shorter length of hospital stay were observed in the laparoscopic group than in the open group. Laparoscopic right hemicolectomy with CME and central vascular ligation is a safe and feasible surgical procedure and should be considered the standard technique for right-sided colon cancer.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1

CONSORT flow diagram of the study.

Figure 2

Pathologic specimens after resection. The mesorectal envelope was preserved.

Figure 3

Several pictures of different patients during surgery and after resection was completed. A: Ileocolic pedicle dissection, B: Gastropancreaticocolic trunk, C: The appearance of the stripped SMV, centrally ligated veins, and ligated arteries at the SMV level in the laparoscopic group after resection was completed, D: The appearance of the stripped SMV, centrally ligated veins and arteries in the open group after resection was completed. SMV = superior mesenteric vein.

Figure 4

Kaplan−Meier survival probability plots. A: Disease-free survival curves; B: Overall survival curves.