ORIGINAL ARTICLES
Comparison of short- and medium-term results between
laparoscopically assisted and totally laparoscopic right
hemicolectomy: a case-control study
Massimiliano Fabozzi
•
Rosaldo Allieta
•
Riccardo Brachet Contul
•
Manuela Grivon
•
Paolo Millo
•
Elena Lale-Murix
•
Mario Nardi Jr.
Received: 6 September 2009 / Accepted: 11 January 2010 / Published online: 21 February 2010
Ó Springer Science+Business Media, LLC 2010
Abstract
Background This study aimed to compare the short- and
medium-term results obtained by totally laparoscopic right
colectomy (TL) with those obtained by laparoscopically
assisted right colectomy (LAC) for the treatment of right
colon cancer.
Methods A retrospective study compared two nonstatis-
tically different groups (50 TL and 50 LAC cases) man-
aged for nonmetastatic malignant tumors. The study
outcomes included operative time, length of minilaparot-
omy, intraoperative complications, postoperative pain, time
to resumption of the gastrointestinal functions, permanence
of abdominal drain, analgesic therapy duration, postoper-
ative complications, hospitalization time, number of har-
vested lymph nodes, and distant metastases onset.
Results The mean operative times were 78 ± 25 min (TL
group) and 92 ± 22 min (LAC group) (p \ 0.05). The
findings showed a lower postoperative pain level associated
with a reduction in analgesic consumption (p [ 0.05) and
earlier restoration of digestive function in the TL group
than in the LAC group. The mean hospital stays were
approximately 5 days (TL) and 7 days (LAC) (p \ 0.05).
No complications occurred either intra- or postoperatively,
and similarly, the TL group experienced no mortality. In
comparison, the LAC group had a 30% complication rate
(p \ 0.05). The complications included one case of intra-
operative small bowel lesion, three cases of postoperative
respiratory infections, three cases of anastomotic leakage,
two cases of intestinal occlusion, three cases of minilapa-
rotomy infection, one case of postoperative femoral neu-
rosis, one case of postoperative heart attack, and one case
of postoperative pancreatitis. The mortality rate was 0%.
Neither group had a recurrence of the neoplastic disease
during a 4-year follow-up period.
Conclusions The findings seem to demonstrate that TL
right colectomy is feasible and safe, yielding results com-
parable with those of the open approach but offering
improved postoperative patient comfort. The limits of this
retrospective comparative study do not allow definitive
conclusions to be drawn despite the encouraging data for
the next prospective randomized studies.
Keywords Intracorporeal anastomosis Á
Laparoscopic right colectomy Á
Laparoscopically assisted right colectomy
Right colectomy is indicated for malignant pathologies
involving the intestinal tract between the ileocecal
Bahuino valve and the colic hepatic flexure. Laparoscopic
resection must respect the same oncologic criteria as the
open approach including the no-touch isolation technique,
isolation and ligation of the vascular pedicles at the
origin, oncologic lymphadenectomy, and distal and
radial clearance of the neoplasm from resection margins
[1, 2].
Laparoscopic surgery is universally accepted and vali-
dated for the treatment of left colonic and rectal oncologic
pathologies, but it has been applied only recently to the
right colon [3–7] for two main reasons: anatomic vari-
ability of the viscera (the cecum may be detected in the
subhepatic or periumbilical region or in the right iliac
fossa) and, most importantly, the anatomic variability of
M. Fabozzi (&) Á R. Allieta Á R. B. Contul Á M. Grivon Á
P. Millo Á E. Lale-Murix Á M. Nardi Jr.
Department of General Surgery,
Aosta Valley Regional Hospital ‘‘Umberto Parini’’,
via Adamello, 16, 11100 Aosta, Italy
e-mail: maxfabozzi@yahoo.fr
123
Surg Endosc (2010) 24:2085–2091
DOI 10.1007/s00464-010-0902-8