Inferior versus medial approach in laparoscopic and robotic surgery with complete mesocolic excision for right-sided...

Right-sided colon cancer surgery is a highly difficult operation, and ensuring perioperative safety is an important issue. While various approaches have been proposed for right-sided colon cancer, there are few reports comparing them. The present study compared the inferior approach (IA) and medial approach (MA) for right-sided colon cancer surgery and evaluated their safety.

We compared 528 cases of right-sided colon cancer surgery performed at our five affiliated institutions from 2017 to 2023, divided into IA and MA groups of 122 cases each using propensity score matching. Short-term outcomes of both groups were retrospectively evaluated, focusing on perioperative complications and perioperative mortality as the primary outcomes.

After propensity score matching, all baseline variables were well balanced. All patients underwent complete mesocolic excision. No statistically significant difference (p < 0.05) was observed between the two groups in the incidence of postoperative complications, and no cases of severe complications were observed in either group. The incidence rates of Clavien-Dindo grade ≥ 3 complications (IA/ MA): anastomotic leakage (0%/ 0.8%); intraabdominal abscess (0.8%/ 1.6%); surgical site infection (0.8%/ 3.2%); ileus (0%/ 0.8%); and anastomotic bleeding: (0%/ 0%). Postoperative hospital stay was significantly shorter in the IA group. Although there was a significant difference in the number of dissected lymph nodes, both groups had good R0 resection rates.

Both IA and MA represent safe and feasible approaches for right-sided colon cancer and can be selected on the basis of the surgeon's preference.