Matsuda Takeru, Yamashita Kimihiro, Hasegawa Hiroshi, Utsumi Masako, Kakeji Yoshihiro
Division of Gastrointestinal Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan.
Division of Minimally Invasive Surgery Department of Surgery Kobe University Graduate School of Medicine Kobe Japan.
Ann Gastroenterol Surg. 2020 Jul 18;4(5):521-527. doi: 10.1002/ags3.12373. eCollection 2020 Sep.
Laparoscopic right hemicolectomy (LRH) is utilized worldwide as one of the standard surgical treatments for right-sided colon cancer. However, there have been issues concerning its applicability, techniques, and trend. The present study aimed to elucidate the current status and trend of LRH by reviewing literature focusing on important issues associated with this surgery. Based on previous studies, LRH most likely provides better short-term outcomes and similar oncological outcomes compared to open surgery. Despite the increasing use of robotic approach in this surgery, it seems to have always been associated with longer operative times and greater hospital cost with limited advantage. Intracorporeal anastomosis seems to improve short-term outcomes, such as quicker recovery of bowel function, compared to extracorporeal anastomosis. However, it does not contribute to shorter hospital stay. With regard to dissection technique, various approaches, and landmarks have been advocated to overcome the technical difficulty in LRH. This difficulty is likely to be caused by anatomical variation, especially in venous structures. The superiority of one approach or landmark over another is still argued about due to the lack of large-scale prospective studies. However, deep understanding both of anatomical variation and characteristics of each approach would be of extreme importance to minimize adverse effects and maximize patient benefit after LRH.
腹腔镜右半结肠切除术（LRH）作为右侧结肠癌的标准外科治疗方法之一在全球范围内得到应用。然而，其适用性、技术和趋势一直存在问题。本研究旨在通过回顾聚焦于此手术相关重要问题的文献，阐明LRH的现状和趋势。基于既往研究，与开放手术相比，LRH极有可能提供更好的短期结局和相似的肿瘤学结局。尽管该手术中机器人手术方式的使用日益增加，但它似乎一直与手术时间延长和更高的住院费用相关，优势有限。与体外吻合相比，体内吻合似乎能改善短期结局，如肠功能恢复更快。然而，它对缩短住院时间并无帮助。关于解剖技术，人们提倡采用各种方法和标志来克服LRH中的技术难题。这种难题可能由解剖变异引起，尤其是静脉结构的变异。由于缺乏大规模前瞻性研究，一种方法或标志相对于另一种方法或标志的优越性仍存在争议。然而，深入了解解剖变异和每种方法的特点对于将LRH术后的不良反应降至最低并使患者获益最大化极为重要。
