Totally laparoscopic right colectomy versus laparoscopically assisted right colectomy: a propensity score analysis

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Laparoscopic right colectomy is a common procedure for various colonic conditions.
• Comparing totally laparoscopic right colectomy (TLRC) and laparoscopically assisted right colectomy (LARC) is crucial for optimizing patient care.
• Propensity score matching (PSM) is essential for reducing bias in comparative surgical studies.

Purpose of the Study:

• To compare the short- and long-term outcomes of TLRC versus LARC.
• To evaluate the safety, efficacy, and oncological accuracy of both surgical approaches.
• To identify potential advantages of TLRC over LARC using PSM analysis.

Main Methods:

• Retrospective analysis of 116 patients undergoing laparoscopic right colectomy (January 2006 - July 2016).
• Propensity score matching (PSM) to create comparable groups of 54 patients for TLRC and 54 for LARC.
• Comparison of post-operative hospital stay, 30-day morbidity/mortality, long-term incisional hernia rates, lymph node yield, and vascular pedicle length.

Main Results:

• TLRC was associated with a significantly shorter post-operative hospital stay (4.79 vs. 6.81 days; p < 0.001).
• No significant differences were observed in 30-day morbidity and mortality between TLRC and LARC.
• TLRC demonstrated a lower incidence of long-term incisional hernias (1.9% vs. 21.2%; p = 0.002) and improved oncological metrics (lymph nodes: 19.21 vs. 15.19; p = 0.001; pedicle length: 131.81 vs. 114.76 mm; p = 0.014).

Conclusions:

• TLRC is a safe and feasible alternative to LARC for right colectomy.
• TLRC offers significant advantages including reduced hospital stay and lower incisional hernia rates.
• Further research is warranted to fully elucidate the long-term oncological benefits of TLRC.