Abstract
Aim: We aimed to examine the early oncological and clinical outcomes of the medial and lateral approaches for right hemicolectomy.
Materials and Methods: Laparoscopic right hemicolectomy patients who underwent medial and lateral approach techniques in our clinic between March 2010 and September 2022 were retrospectively reviewed. Demographic data of the patients, tumor, and operation characteristics, operation, clinical, pathological, mortality, and morbidity outcomes were recorded. Data were compared with the Chi-square test or Fisher Exact test according to the expected value for categorical variables. The Mann-Whitney U test was used because the data for continuous variables were not normally distributed.
Results: In total, hundred and fourteen patients who underwent laparoscopic right colon resection were included. 47 patients were operated on with the medial approach, and 67 with the lateral approach. In terms of harvested lymph node number, operation time, estimated blood loss, first fluid intake, first solid intake, first flatus, blood transfusion history, length of stay, anastomotic leaks, and mortality were not significantly different between the two approaches (p>0.05). However, the number of positive lymph nodes was significantly higher in the medial approach (p=0.013).
Conclusion: The medial and lateral approaches are feasible and effective techniques for right hemicolectomy. There is no difference between the short-term oncologic results. However, randomized controlled studies are needed for long-term results.
References
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan;72(1):7-33.
- gco.iarc.fr [Homepage on the Internet]. International Agency for Research on Cancer, World Health Organization Online Resources [updated 10 October 2022, cited 20 October 2022]. Available from: https://gco.iarc.fr/today/home
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33.
- McCombie AM, Frizelle F, Bagshaw PF, et al. The ALCCaS Trial: A Randomized Controlled Trial Comparing Quality of Life Following Laparoscopic Versus Open Colectomy for Colon Cancer. Dis Colon Rectum. 2018 Oct;61(10):1156-62.
- Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020 May;70(3):145-64.
- Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003 Aug 1;21(15):2912-9.
- Peeples C, Shellnut J, Wasvary H, Riggs T, Sacksner J. Predictive factors affecting survival in stage II colorectal cancer: is lymph node harvesting relevant? Dis Colon Rectum. 2010 Nov;53(11):1517-23.
- Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005 Dec 1;23(34):8706-12.
- Ding J, Liao GQ, Xia Y, et al. Medial versus lateral approach in laparoscopic colorectal resection: a systematic review and meta-analysis. World J Surg. 2013 Apr;37(4):863-72.
- Luo W, Cai Z, Li F, et al. Laparoscopic Complete Mesocolic Excision with Central Vascular Ligation (CME + CVL) for Right-Sided Colon Cancer: A New "Superior Mesenteric Artery First" Approach. Ann Surg Oncol. 2022 Aug;29(8):5066-73.
- Metcalf AM. Laparoscopic colectomy. Surg Clin North Am. 2000 Aug;80(4):1321-6.
- Young-Fadok TM, Nelson H. Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum. 2000 Feb;43(2):267-71; discussion 271-3.
- Larson DW, Nelson H. Laparoscopic colectomy for cancer. J Gastrointest Surg. 2004 Jul-Aug;8(5):636-42.
- Ballantyne GH, Ewing D, Pigazzi A, Wasielewski A. Telerobotic-assisted laparoscopic right hemicolectomy: lateral to medial or medial to lateral dissection? Surg Laparosc Endosc Percutan Tech. 2006 Dec;16(6):406-10.
- Veldkamp R, Gholghesaei M, Bonjer HJ, et al. Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc. 2004 Aug;18(8):1163-85.
- Honaker M, Scouten S, Sacksner J, Ziegler M, Wasvary H. A medial to lateral approach offers a superior lymph node harvest for laparoscopic right colectomy. Int J Colorectal Dis. 2016 Mar;31(3):631-4.
- Rotholtz NA, Bun ME, Tessio M, et al. Laparoscopic colectomy: medial versus lateral approach. Surg Laparosc Endosc Percutan Tech. 2009 Feb;19(1):43-7.
- Fielding LP, Arsenault PA, Chapuis PH, et al. Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol. 1991 Jul-Aug;6(4):325-44.
- Zhang B, Lv M, Chen T, et al. The association between lymph node resection and postoperative survival in patients with colorectal cancer. Hepatogastroenterology. 2013 Nov-Dec;60(128):1922-6.
- Rosenberg R, Friederichs J, Schuster T, et al. Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg. 2008 Dec;248(6):968-78.
- Xu P, Ren L, Zhu D, et al. Open Right Hemicolectomy:Lateral to Medial or Medial to Lateral Approach? PLoS One. 2015 Dec 31;10(12):e0145175.
- Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH. Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg. 2007 Jun;11(6):778-82.
- Yan J, Ying MG, Zhou D, et al. A prospective randomized control trial of the approach for laparoscopic right hemi-colectomy:medial-to-lateral versus lateral-to-medial. Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Jun;13(6):403-5.
Abstract
Amaç: Sağ hemikolektomi için medial ve lateral yaklaşımların erken onkolojik ve klinik sonuçlarını incelemeyi amaçladık.
Gereç ve Yöntem: Mart 2010-Eylül 2022 tarihleri arasında kliniğimizde medial ve lateral yaklaşım teknikleri ile opere edilen laparoskopik sağ hemikolektomi hastaları retrospektif yöntemle incelendi. Hastaların demografik verileri, tümör ve operasyon özellikleri, operasyon, klinik, patolojik, mortalite ve morbidite sonuçları kaydedildi. Gruplar, kategorik değişkenler için beklenen değere göre Ki-kare testi veya Fisher Exact testi ile karşılaştırıldı. Sürekli değişkenler için veriler normal dağılmadığından dolayı Mann-Whitney U testi kullanıldı.
Bulgular: Çalışmaya laparoskopik sağ kolon rezeksiyonu uygulanan 114 hasta dahil edildi. 47 hasta medial yaklaşımla, 67 hasta lateral yaklaşımla opere edildi. Alınan lenf nodu sayısı, operasyon süresi, tahmini kan kaybı, ilk sıvı alımı, ilk katı alımı, ilk gaz, kan transfüzyonu öyküsü, hastanede kalış süresi, anastomoz kaçağı ve mortalite açısından her iki yaklaşımda da anlamlı fark bulunmadı (p >0,05). Pozitif lenf nodu sayısı, medial yaklaşımda istatistiksel olarak anlamlı derecede yüksekti (p=0,013).
Sonuç: Sağ hemikolektomi için laparoskopik cerrahi teknikler arasında medial ve lateral yaklaşımlar uygulanabilir ve etkilidir. Kısa dönem onkolojik sonuçlar arasında fark yoktur. Ancak uzun dönemli sonuçlar için randomize kontrollü çalışmalara ihtiyaç vardır.
Supporting Institution
Yok
References
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan;72(1):7-33.
- gco.iarc.fr [Homepage on the Internet]. International Agency for Research on Cancer, World Health Organization Online Resources [updated 10 October 2022, cited 20 October 2022]. Available from: https://gco.iarc.fr/today/home
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33.
- McCombie AM, Frizelle F, Bagshaw PF, et al. The ALCCaS Trial: A Randomized Controlled Trial Comparing Quality of Life Following Laparoscopic Versus Open Colectomy for Colon Cancer. Dis Colon Rectum. 2018 Oct;61(10):1156-62.
- Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020 May;70(3):145-64.
- Le Voyer TE, Sigurdson ER, Hanlon AL, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003 Aug 1;21(15):2912-9.
- Peeples C, Shellnut J, Wasvary H, Riggs T, Sacksner J. Predictive factors affecting survival in stage II colorectal cancer: is lymph node harvesting relevant? Dis Colon Rectum. 2010 Nov;53(11):1517-23.
- Berger AC, Sigurdson ER, LeVoyer T, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005 Dec 1;23(34):8706-12.
- Ding J, Liao GQ, Xia Y, et al. Medial versus lateral approach in laparoscopic colorectal resection: a systematic review and meta-analysis. World J Surg. 2013 Apr;37(4):863-72.
- Luo W, Cai Z, Li F, et al. Laparoscopic Complete Mesocolic Excision with Central Vascular Ligation (CME + CVL) for Right-Sided Colon Cancer: A New "Superior Mesenteric Artery First" Approach. Ann Surg Oncol. 2022 Aug;29(8):5066-73.
- Metcalf AM. Laparoscopic colectomy. Surg Clin North Am. 2000 Aug;80(4):1321-6.
- Young-Fadok TM, Nelson H. Laparoscopic right colectomy: five-step procedure. Dis Colon Rectum. 2000 Feb;43(2):267-71; discussion 271-3.
- Larson DW, Nelson H. Laparoscopic colectomy for cancer. J Gastrointest Surg. 2004 Jul-Aug;8(5):636-42.
- Ballantyne GH, Ewing D, Pigazzi A, Wasielewski A. Telerobotic-assisted laparoscopic right hemicolectomy: lateral to medial or medial to lateral dissection? Surg Laparosc Endosc Percutan Tech. 2006 Dec;16(6):406-10.
- Veldkamp R, Gholghesaei M, Bonjer HJ, et al. Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc. 2004 Aug;18(8):1163-85.
- Honaker M, Scouten S, Sacksner J, Ziegler M, Wasvary H. A medial to lateral approach offers a superior lymph node harvest for laparoscopic right colectomy. Int J Colorectal Dis. 2016 Mar;31(3):631-4.
- Rotholtz NA, Bun ME, Tessio M, et al. Laparoscopic colectomy: medial versus lateral approach. Surg Laparosc Endosc Percutan Tech. 2009 Feb;19(1):43-7.
- Fielding LP, Arsenault PA, Chapuis PH, et al. Clinicopathological staging for colorectal cancer: an International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT). J Gastroenterol Hepatol. 1991 Jul-Aug;6(4):325-44.
- Zhang B, Lv M, Chen T, et al. The association between lymph node resection and postoperative survival in patients with colorectal cancer. Hepatogastroenterology. 2013 Nov-Dec;60(128):1922-6.
- Rosenberg R, Friederichs J, Schuster T, et al. Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period. Ann Surg. 2008 Dec;248(6):968-78.
- Xu P, Ren L, Zhu D, et al. Open Right Hemicolectomy:Lateral to Medial or Medial to Lateral Approach? PLoS One. 2015 Dec 31;10(12):e0145175.
- Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH. Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg. 2007 Jun;11(6):778-82.
- Yan J, Ying MG, Zhou D, et al. A prospective randomized control trial of the approach for laparoscopic right hemi-colectomy:medial-to-lateral versus lateral-to-medial. Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Jun;13(6):403-5.
Details
| Primary Language | English |
|---|---|
| Subjects | Oncologic Surgery, Clinical Oncology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 18, 2023 |
| Submission Date | October 21, 2022 |
| Published in Issue | Year 2023Volume: 62 Issue: 3 |
