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Medial-to-lateral vs. Lateral-to-medial: Determining the Optimal Approach in Laparoscopic Right Hemicolectomy-A
Hua Chai1, Zhiyong Shen1, Shuang Jiang1
1Department of General Surgery, Jiangwan Hospital of Hongkou District, 200081 Shanghai, China.
Aim:
To check the immediate and distant results of medial-to-lateral (ML) and lateral-to-medial (LM) methods to laparoscopic right hemicolectomy.
Methods:
The present study is a retrospective cohort analysis of 453 laparoscopic right hemicolectomy procedures performed between 2018 and 2024 at a single Chinese tertiary care hospital, comparing LM and ML techniques. Rates of conversion, complications, lymph node yield, and survival were the main results. Operating room conditions and recovery measures served as secondary outcomes. Kaplan-Meier techniques were utilized for survival analysis, and propensity score matching was employed to reduce bias in selection.
Results:
Among 453 patients (mean [SD] age, 60 [12] years; 294 men [65%]), 289 (64%) underwent the ML approach. The ML technique exhibited significantly reduced conversion rates (11% vs. 63%; p < 0.001), fewer Grade III-IV complications (4.8% vs. 68%; p < 0.001), and a lower lymph node yield (32.5% vs. 67.5% reaching ≥12 nodes; p = 0.001). Survival outcomes improved with the ML approach: overall survival (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.62-0.93; p = 0.008) and disease-free survival (HR, 0.71; 95% CI, 0.58-0.87; p = 0.001). Following propensity score matching, the LM method (n = 164) showed higher operative success (70.9% vs. 29.1%; adjusted odds ratio [aOR], 2.14; 95% CI, 1.56-2.94; p < 0.001) and LM showed reduced major complications (9.8% vs. 90.2%; adjusted OR, 0.52; 95% CI, 0.38-0.71; p < 0.001) compared to the ML approach.
Conclusions:
The ML approach in laparoscopic right hemicolectomy shows superior oncological outcomes and survival pre-matching, while LM excels in operative success and recovery post-matching. ML is preferred when feasible, but further validation is needed.
