Laparoscopic right colectomy vs laparoscopic-assisted colonoscopic polypectomy for endoscopically unresectable...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Endoscopic management of large or difficult-to-resect colorectal polyps remains a challenge.
• Surgical resection is often considered for polyps deemed unresectable via standard colonoscopy.
• Laparoscopic right colectomy (LRC) and laparoscopic-assisted colonoscopic polypectomy (LACP) are potential treatment options.

Purpose of the Study:

• To compare complication rates and length of stay (LOS) between LRC and LACP for endoscopically unresectable right colon polyps.
• To test the null hypothesis of no significant difference between the two procedures.

Main Methods:

• A single-center randomized controlled trial (RCT) involving 34 patients with unresectable right colon polyps.
• Patients were randomized to either LRC or LACP.
• Exclusion criteria included nonlift sign, dysplasia, adenocarcinoma, inflammatory bowel disease, and familial adenomatous polyposis.

Main Results:

• No significant differences were observed in postoperative complications, readmissions, or reoperations between LRC and LACP.
• LRC was associated with longer operating times, increased intravenous fluid requirements, and delayed return to solid food intake.
• Patients undergoing LACP had a significantly shorter postoperative length of stay (LOS) compared to LRC (2.63 vs 4.94 days).

Conclusions:

• Laparoscopic-assisted colonoscopic polypectomy (LACP) and laparoscopic right colectomy (LRC) demonstrate comparable safety profiles regarding complication rates for unresectable right colon polyps.
• LACP is associated with a significantly reduced length of hospital stay compared to LRC.
• LACP emerges as a potentially more efficient therapeutic approach for selected cases of unresectable colorectal polyps.