Laparoscopic versus open complete mesocolic excision for right cancer colon

Abstract

Introduction. This study aims to assess and compare the pathological, oncological and perioperative surgical outcomes of CME for right colon cancer by open and laparoscopic approaches. Material and methods. This is a prospective randomized study that included all patients that underwent radical right hemicolectomy with CME for right colon cancer at the Department of General Surgery, Assiut University between January 2017 and December 2018. Follow up of the patients continued till January 2020. Patients were randomized into two groups: the first group for open CME and the second group for laparoscopic CME. Demographic, operative, pathologic and oncological parameters were analysed. Results. This study enrolled 35 patients with colon cancer that were randomly sub-grouped into the open CME group (n = 18) and laparoscopic CME group (n = 17) according to the surgical approach. Both groups had insignificant differences as regard mesocolon grading, vascular tie, circumferential safety margin, total lymph nodes and positive lymph nodes. Patients who underwent open CME had significantly shorter operative time [168.83 ± 23.50 vs. 205.17 ± 35.70 (minutes); p < 0.001] and significantly higher blood loss in comparison to those underwent laparoscopic CME [353.89 ± 85.70 vs. 224.11 ± 96.51 (cc); p < 0.001]. Patients underwent laparoscopic CME had significantly shorter time of passage of flatus [1.45 ± 0.23 vs. 2.34 ± 0.79 (days); p < 0.001] and first bowel motion [1.92 ± 0.38 vs. 2.79 ± 0.95 (days); p = 0.01], and less postoperative pain score and shorter hospital stay in comparison to those underwent open CME. There was no significant difference between the open group and the laparoscopic group as regard mean overall survival duration [23.44 vs. 23.29 (month); p = 0.36] Conclusions. Our study supports the use of laparoscopic CME for right colonic cancer if good surgical expertise is present. It is a feasible and safe procedure with better postoperative short and long-term surgical outcomes and similar pathological and oncological outcomes if compared to the open approach.