Surgery, Gastroenterology and Oncology
Vol. 25, Nr. 5, Dec 2020
Laparoscopic versus Open Complete Mesocolic Excision and D3 Lymphadenectomy in Right Colon Carcinoma
Ali Zedan Tohamy, Hanan A. Eltyb, Marwa T. Hussiez, Haisam Atta
ORIGINAL PAPER, Dec 2020
Article DOI: 10.21614/sgo-25-5-260
Background and objectives: Complete mesocolic excision (CME) technique seems to be gaining popularity in cancer colon management. We aim to compare the laparoscopic approach for CME with the open approach in right colon cancer treatment regarding the feasibility, safety and perioperative and oncologic outcomes.

Patients and methods: A prospective study which included all patients that underwent radical right hemicolectomy for pathologic confirmed stage II or stage III tumor with CME at South Egypt Cancer Institute, Assiut University from January 2012 to December 2019.
Patients were grouped according to the surgical approach into the laparoscopic colectomy (LCME) group (n=48) or the open colectomy (OCME) group (n=48).

Results: The mean operative time was significantly longer in the LCME group than in the OCME group with less mean intraoperative blood loss. The conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes than in 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 and shorter time interval to liquid and normal diet after surgery.
The postoperative hospital stay was significantly shorter in the LCME group (9.13+-1.57 day) than in the OCME group (13.04+-3.07 day). The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2 %), (P=0.252).
The 3-years OS in the LCME group was similar to that in OCME (78.2% vs 63.2%, respectively, P-value = 0.423). The three years DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%) but didnâ??t 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 the management of patients with stage II or III colon cancer.

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Surgery, Gastroenterology and Oncology is indexed in Scopus, CrossRef (DOI: 10.21614/sgo)



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