Laparoscopic right hemicolectomy oriented by superior mesenteric artery for right colon cancer: efficacy evaluation with a match-controlled analysis
Authors Dai W, Zhang J, Xiong W, Xu J, Cai S, Tan M, He Y, Song W, Yuan Y
Received 25 June 2018
Accepted for publication 8 August 2018
Published 30 October 2018 Volume 2018:10 Pages 5157—5170
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Antonella D'Anneo
Weigang Dai,1,2,* Jian Zhang,1,2,* Weixin Xiong,1,2 Jianbo Xu,1,2 Shirong Cai,1,2 Min Tan,1,2 Yulong He,1,2 Wu Song,1,2 Yujie Yuan1,2
1Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, People’s Republic of China; 2Center of Gastric Cancer, Sun Yat-sen University, Guangzhou 510080, Guangdong, People’s Republic of China
*These authors contributed equally to this work
Background: Laparoscopic right hemicolectomy (LRC) with a principle of D3 lymphadenectomy seems to be appropriate in treatment of right-sided colon cancer (RCC). This study aimed to evaluate clinical efficacy of superior mesenteric artery (SMA)-guided LRC (SLRC) for RCC patients.
Patients and methods: Data for RCC patients with radical resection were retrieved from our database and electronic medical records (January 2010 to December 2014). Patients undergoing SLRC procedure were compared with those undergoing conventional laparoscopic right hemicolectomy (CLRC), with a match ratio of 1:2 for group balance. Perioperative and long-term outcomes were compared between two groups.
Results: In sum, 102 matched patients were selected, with a median follow-up of 32 (range, 3–68) months. The mean operative time was significantly reduced in the SLRC group compared to the CLRC group (206.9 vs 240.0 minutes, P=0.007), with increased incidence of postoperative complications observed (14.7% vs 8.8%, P=0.499). Average length of stay after surgery (7.4 vs 8.0 days), estimated blood loss (85.3 vs 105.4 mL), number of harvested (28.4 vs 28.2) and positive (0.6 vs 0.9) lymph nodes, and overall costs ($4826.9 vs $4874.6) were comparable between two groups (P>0.05). The 3-year disease-free survival rate (89.4% vs 92.1%, P=0.840) and overall survival rate (93.0% vs 83.1%, P=0.273) were similar in both groups. Older age (≥65 years, P=0.049) and advanced tumor stage (≥II, P=0.009) were independent risk factors of recurrence.
Conclusion: The perioperative and oncologic outcomes of SLRC were not superior, but comparable to CLRC. SMA-guided dissection was a feasible surgical approach in treatment of RCC.
Keywords: right colon cancer, right hemicolectomy, laparoscopic surgery, D3 lymphadenectomy, outcomes
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