Department of Oncology Surgery, King Hussein Cancer Center, Amman, Jordan.
Surg Laparosc Endosc Percutan Tech. 2020 Jul 29;31(1):56-60. doi: 10.1097/SLE.0000000000000843.
The open approach to right hemicolectomy remains the most widely adopted, whereas laparoscopic surgery is technically more demanding with possible loss of benefit for lengthy procedures compared with open surgery. The aim of this study is to compare the outcomes of the laparoscopic versus open surgery for right colon cancer resections.
Patients who underwent an elective and potentially curative right colectomy for colon cancer between 2015 and 2019 were included and those who underwent emergency surgery, palliative resection, or cytoreductive surgery were excluded. Patients were randomly matched on 1:2 basis for age, disease stage, neoadjuvant chemotherapy, and extent of colectomy (right vs. extended right hemicolectomy, and additional major resection). The analysis was conducted on an intention-to-treat basis. The outcomes were reported as median (range) or percent as appropriate.
Among 160 patients, 18 were excluded. The final matching included 69 patients. The were no significant differences between the groups regarding patients' age and sex distribution, tumor size, and preoperative serum albumin and hemoglobin. There were 2 conversions (8.7%) to open surgery. Although the operating time for laparoscopic surgery was longer (200 vs. 140 min, P<0.001), it was associated with less blood loss (50 vs. 100 mL, P=0.001) and shorter primary and total hospital stay (4.1 vs. 6.0 days, P<0.001). There were no differences in the rates of severe complications (0% vs. 13%), reoperations (0% vs. 4.3%), readmissions (13% vs. 8.7%), mortality (0% vs. 2.2%), R0 resections (95.7% vs. 97.8%), and lymph node retrieval rate (28 in each group).
The laparoscopic approach to right colon resection for colon cancer is associated with less operative trauma and quicker recovery compared with open surgery and offers an equivalent oncologic resection.
右半结肠切除术的开放性方法仍然是最广泛采用的方法，而腹腔镜手术在技术上要求更高，与开放性手术相比，对于较长的手术可能会失去益处。本研究旨在比较腹腔镜与开放性手术治疗右半结肠癌的结果。
纳入 2015 年至 2019 年间接受择期和潜在根治性右结肠切除术治疗结肠癌的患者，排除接受急诊手术、姑息性切除术或细胞减灭术的患者。根据年龄、疾病分期、新辅助化疗和结肠切除术范围（右半结肠切除术与扩大右半结肠切除术，以及额外的主要切除术），以 1:2 的比例对患者进行随机匹配。分析基于意向治疗进行。结果以中位数（范围）或适当的百分比报告。
在 160 名患者中，有 18 名被排除。最终匹配包括 69 名患者。两组患者的年龄和性别分布、肿瘤大小以及术前血清白蛋白和血红蛋白无显著差异。有 2 例（8.7%）转为开放性手术。尽管腹腔镜手术的手术时间较长（200 分钟比 140 分钟，P<0.001），但出血量较少（50 毫升比 100 毫升，P=0.001），且初次和总住院时间较短（4.1 天比 6.0 天，P<0.001）。严重并发症发生率（0%比 13%）、再次手术率（0%比 4.3%）、再入院率（13%比 8.7%）、死亡率（0%比 2.2%）、R0 切除率（95.7%比 97.8%）和淋巴结检出率（每组 28 个）无差异。
与开放性手术相比，腹腔镜右半结肠癌切除术具有较少的手术创伤和更快的恢复速度，并且提供了等效的肿瘤学切除。
