Laparoscopic versus Open Complete Mesocolic Excision for Right Colon Cancer

Ali Zedan, Essam Elshiekh, Mohamed I Omar, Mohamad Raafat, Salah M Khallaf, Haisam Atta, Marwa T Hussien, Ali Zedan, Essam Elshiekh, Mohamed I Omar, Mohamad Raafat, Salah M Khallaf, Haisam Atta, Marwa T Hussien

Abstract

Results: The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P=0.010). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) (P=0.252). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance (P value = 0.266).

Conclusions: In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2021 Ali Zedan et al.

Figures

Figure 1
Figure 1
Surgical technique and pathologic examination. (a) Open CME with division of feeding vessels at their origin. (b) Laparoscopic CME showing clipped ileocolic vessels at their origin from superior mesenteric vessels. (c) Side-to-side stapled ileocolic anastomosis after LCME right hemicolectomy with use of wound protector. (d) CME specimen for gross pathologic assessment before fixation.
Figure 2
Figure 2
Kaplan–Meier survival function curve. It shows comparable survival rates between the 2 study groups regarding relapse-free survival rates.

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