Skip to main content

Advertisement

SpringerLink
Log in

Reduced port versus open right hemicolectomy for colorectal cancer: a retrospective comparison study of two centers

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The concept of complete mesocolic excision (CME) in right-sided colorectal cancer is well known for open and laparoscopic surgery. The aim of this study was to evaluate and compare perioperative and oncological outcomes of reduced port and open surgery for right-sided colorectal cancer.

Methods

One hundred forty-one patients received elective surgery for right-sided colonic cancer between January 2015 and December 2019 and were included in a retrospective database.

Results

We observed longer operation time in the RP-CME group (145 min vs. 119.43 min, p<0.01). Hospital stay (8 days vs. 14 days, p<0.01) and time to first intestinal passage (42 h. vs. 59 h, p<0.01) were significantly shorter in the reduced port group. Postoperative complications were more likely to be observed in the O-CME group (7.2% vs. 14.1%, p=0.28); anastomotic leakage rate was low in both groups (1.8% vs. 2.4%, p=1.00). Specimen scores (score 1= good: 93.8% vs. 91.7%, p=1.00) and average number of retrieved lymph nodes were comparable (24 vs. 23 p=0.69). In O-CME patients, we observed more advanced tumor stages (UICC III: 21.4% vs. 45.9%, p<0.01).

Conclusion

To our knowledge, this is the first study comparing reduced port to open surgery for right-sided colorectal cancer. We could demonstrate that this technique is feasible for oncological right hemicolectomy with observation of shorter hospital stay and lower morbidity rates compared to open surgery. The oncological outcome did not differ in the present study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

n/a

References

  1. Zavoral M, Suchanek S, Zavada F, Dusek L, Muzik J, Seifert B, Fric P (2009) Colorectal cancer screening in Europe. World J Gastroenterol 15:5907–5915. https://doi.org/10.3748/wjg.15.5907

    Article  PubMed  PubMed Central  Google Scholar 

  2. Curado MP (ed) (2008) Cancer incidence in five continents. IARC scientific publications, vol 160. International Agency for Research on Cancer, Lyon

    Google Scholar 

  3. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18:581–592. https://doi.org/10.1093/annonc/mdl498

    Article  CAS  PubMed  Google Scholar 

  4. Kang J, Kim I-k, Kang SI et al (2014) Laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc 28:2747–2751. https://doi.org/10.1007/s00464-014-3521-y

    Article  PubMed  Google Scholar 

  5. Li JC-M, Leung KL, Ng SS-M, Liu SYW, Lee JFY, Hon SSF (2012) Laparoscopic-assisted versus open resection of right-sided colonic cancer--a prospective randomized controlled trial. Int J Color Dis 27:95–102. https://doi.org/10.1007/s00384-011-1294-5

    Article  Google Scholar 

  6. Lim SW, Kim HR, Kim YJ (2014) Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy. Ann Surg Treat Res 87:131–138. https://doi.org/10.4174/astr.2014.87.3.131

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sheng Q-S, Pan Z, Chai J, Cheng XB, Liu FL, Wang JH, Chen WB, Lin JJ (2017) Complete mesocolic excision in right hemicolectomy: comparison between hand-assisted laparoscopic and open approaches. Ann Surg Treat Res 92:90–96. https://doi.org/10.4174/astr.2017.92.2.90

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zheng M-H, Feng B, Hu C-Y, Lu AG, Wang ML, Li JW, Hu WG, Zang L, Mao ZH, Dong TT, Dong F, Cai W, Ma JJ, Zong YP, Li MKW (2010) Long-term outcome of laparoscopic total mesorectal excision for middle and low rectal cancer. Minim Invasive Ther Allied Technol 19:329–339. https://doi.org/10.3109/13645706.2010.527771

    Article  PubMed  Google Scholar 

  9. Kim NK, Kim YW, Han YD, Cho MS, Hur H, Min BS, Lee KY (2016) Complete mesocolic excision and central vascular ligation for colon cancer: principle, anatomy, surgical technique, and outcomes. Surg Oncol 25:252–262. https://doi.org/10.1016/j.suronc.2016.05.009

    Article  PubMed  Google Scholar 

  10. Kim IY, Kim BR, Choi EH, Kim YW (2016) Short-term and oncologic outcomes of laparoscopic and open complete mesocolic excision and central ligation. Int J Surg 27:151–157. https://doi.org/10.1016/j.ijsu.2016.02.001

    Article  PubMed  Google Scholar 

  11. Adamina M, Manwaring ML, Park K-J, Delaney CP (2012) Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc 26:2976–2980. https://doi.org/10.1007/s00464-012-2294-4

    Article  PubMed  Google Scholar 

  12. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, Bonjer HJ, COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218. https://doi.org/10.1016/S1470-2045(13)70016-0

    Article  PubMed  Google Scholar 

  13. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645. https://doi.org/10.1002/bjs.7160

    Article  CAS  PubMed  Google Scholar 

  14. Esposito C (1998) One-trocar appendectomy in pediatric surgery. Surg Endosc 12:177–178. https://doi.org/10.1007/s004649900624

    Article  CAS  PubMed  Google Scholar 

  15. Bae SU, Baek SJ, Min BS, Baik SH, Kim NK, Hur H (2015) Reduced-port laparoscopic surgery for a tumor-specific mesorectal excision in patients with colorectal cancer: initial experience with 20 consecutive cases. Ann Coloproctol 31:16–22. https://doi.org/10.3393/ac.2015.31.1.16

    Article  PubMed  PubMed Central  Google Scholar 

  16. Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9:361–364. https://doi.org/10.1089/lap.1999.9.361

    Article  CAS  PubMed  Google Scholar 

  17. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 69:613–616. https://doi.org/10.1002/bjs.1800691019

    Article  CAS  PubMed  Google Scholar 

  18. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Color Dis 11:354–364; discussion 364-5. https://doi.org/10.1111/j.1463-1318.2008.01735.x

    Article  CAS  Google Scholar 

  19. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278. https://doi.org/10.1200/JCO.2009.24.1448

    Article  PubMed  Google Scholar 

  20. Feng B, Sun J, Ling T-L, Lu AG, Wang ML, Chen XY, Ma JJ, Li JW, Zang L, Han DP, Zheng MH (2012) Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc 26:3669–3675. https://doi.org/10.1007/s00464-012-2435-9

    Article  PubMed  Google Scholar 

  21. Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, de Beaux AC, Deerenberg EB, East B, Fortelny RH, Gillion JF, Henriksen NA, Israelsson L, Jairam A, Jänes A, Jeekel J, López-Cano M, Miserez M, Morales-Conde S, Sanders DL, Simons MP, Śmietański M, Venclauskas L, Berrevoet F, European Hernia Society (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24. https://doi.org/10.1007/s10029-014-1342-5

    Article  CAS  PubMed  Google Scholar 

  22. West NP, Morris EJA, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865. https://doi.org/10.1016/S1470-2045(08)70181-5

    Article  PubMed  Google Scholar 

  23. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 2.1,2019, AWMF Registrierungsnummer: 021/007OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/kolorektales-karzinom/Deutsche S3 Leitline. Accessed 26 June 2020

  24. Strey CW, Wullstein C, Adamina M, Agha A, Aselmann H, Becker T, Grützmann R, Kneist W, Maak M, Mann B, Moesta KT, Runkel N, Schafmayer C, Türler A, Wedel T, Benz S (2018) Laparoscopic right hemicolectomy with CME: standardization using the "critical view" concept. Surg Endosc 32:5021–5030. https://doi.org/10.1007/s00464-018-6267-0

    Article  PubMed  PubMed Central  Google Scholar 

  25. Liang J-T, Lai H-S, Huang K-C, Chang KJ, Shieh MJ, Jeng YM, Wang SM (2003) Comparison of medial-to-lateral versus traditional lateral-to-medial laparoscopic dissection sequences for resection of rectosigmoid cancers: randomized controlled clinical trial. World J Surg 27:190–196. https://doi.org/10.1007/s00268-002-6437-y

    Article  PubMed  Google Scholar 

  26. Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH (2007) Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg 11:778–782. https://doi.org/10.1007/s11605-007-0120-4

    Article  PubMed  Google Scholar 

  27. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL, European Association of Endoscopic Surgery (EAES) (2004) Laparoscopic resection of colon Cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18:1163–1185. https://doi.org/10.1007/s00464-003-8253-3

    Article  CAS  PubMed  Google Scholar 

  28. Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2014) Laparoscopic-assisted versus open complete mesocolic excision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol 21:2288–2294. https://doi.org/10.1245/s10434-014-3614-9

    Article  PubMed  Google Scholar 

  29. Bot J, Piessen G, Robb WB, Roger V, Mariette C (2013) Advanced tumor stage is an independent risk factor of postoperative infectious complications after colorectal surgery: arguments from a case-matched series. Dis Colon Rectum 56:568–576. https://doi.org/10.1097/DCR.0b013e318282e790

    Article  PubMed  Google Scholar 

  30. Mori S, Baba K, Yanagi M, Kita Y, Yanagita S, Uchikado Y, Arigami T, Uenosono Y, Okumura H, Nakajo A, Maemuras K, Ishigami S, Natsugoe S (2015) Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer. Surg Endosc 29:34–40. https://doi.org/10.1007/s00464-014-3650-3

    Article  PubMed  Google Scholar 

  31. Siani LM, Garulli G (2016) Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: a comprehensive review. World J Gastrointest Surg 8:106–114. https://doi.org/10.4240/wjgs.v8.i2.106

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kim HJ, Lee IK, Lee YS, Kang WK, Park JK, Oh ST, Kim JG, Kim YH (2009) A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer. Surg Endosc 23:1812–1817. https://doi.org/10.1007/s00464-009-0348-z

    Article  CAS  PubMed  Google Scholar 

  33. Gouvas N, Tsiaoussis J, Pechlivanides G, Tzortzinis A, Dervenis C, Avgerinos C, Xynos E (2009) Quality of surgery for rectal carcinoma: comparison between open and laparoscopic approaches. Am J Surg 198:702–708. https://doi.org/10.1016/j.amjsurg.2008.10.020

    Article  PubMed  Google Scholar 

  34. Gouvas N, Pechlivanides G, Zervakis N, Kafousi M, Xynos E (2012) Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Color Dis 14:1357–1364. https://doi.org/10.1111/j.1463-1318.2012.03019.x

    Article  CAS  Google Scholar 

  35. Ng K-S, West NP, Scott N, Holzgang M, Quirke P, Jayne DG (2020) What factors determine specimen quality in colon cancer surgery? A cohort study. Int J Color Dis 35:869–880

    Article  Google Scholar 

  36. Shin JW, Amar AHY, Kim SH, Kwak JM, Baek SJ, Cho JS, Kim J (2014) Complete mesocolic excision with D3 lymph node dissection in laparoscopic colectomy for stages II and III colon cancer: long-term oncologic outcomes in 168 patients. Tech Coloproctol 18:795–803. https://doi.org/10.1007/s10151-014-1134-z

    Article  CAS  PubMed  Google Scholar 

  37. Di Buono G, Buscemi S, Cocorullo G et al (2020) Feasibility and safety of laparoscopic complete mesocolic excision (CME) for right-sided colon cancer: short-term outcomes. A Randomized Clinical Study. Ann Surg Publish Ahead of Print. https://doi.org/10.1097/SLA.0000000000004557

  38. An MS, Baik H, Oh SH, Park YH, Seo SH, Kim KH, Hong KH, Bae KB (2018) Oncological outcomes of complete versus conventional mesocolic excision in laparoscopic right hemicolectomy. ANZ J Surg 88:E698–E702. https://doi.org/10.1111/ans.14493

    Article  PubMed  Google Scholar 

  39. Hwang DY, Lee GR, Kim JH, Lee YS (2020) Laparoscopic complete mesocolic excision with D3 lymph node dissection for right colon cancer in elderly patients. Sci Rep 10:12633. https://doi.org/10.1038/s41598-020-69617-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Enomoto M, Katsumata K, Kasahara K, Tago T, Okazaki N, Wada T, Kuwabara H, Mazaki J, Ishizaki T, Nagakawa Y, Tsuchida A (2020) Laparoscopic complete mesocolic excision with true central vascular ligation for right-sided colon cancer. Surg Endosc 34:5640–5641. https://doi.org/10.1007/s00464-020-07867-z

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Simone Minikus for English and spelling corrections.

Author information

Author notes

  1. Peter Tschann and Gerald Seitinger contributed equally to this work.

Authors and Affiliations

  1. Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800, Feldkirch, Austria

    Peter Tschann, Daniel Lechner, Stephanie Adler, Benedikt Feurstein, Paolo N. C. Girotti & Ingmar Königsrainer

  2. Department of Surgery, Hospital St. John of God, Graz, Austria

    Gerald Seitinger, Theresa Schmölzer & Felix Aigner

  3. Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria

    Philipp Szeverinski

  4. Private University in the Principality of Liechtenstein, Triesen, Liechtenstein

    Philipp Szeverinski

Authors
  1. Peter Tschann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gerald Seitinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Lechner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benedikt Feurstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paolo N. C. Girotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Theresa Schmölzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Philipp Szeverinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Felix Aigner
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ingmar Königsrainer
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PT, GS, DL, SA, BF, PG, TS, PS, FA, and IK designed the study. Collection of data was done by PT, GS, and TS. PT wrote the manuscript and prepared the tables. DL, PS, and PT did the statistical analysis. All authors contributed toward data acquisition, data interpretation, and critical revision of the content of the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Peter Tschann.

Ethics declarations

Ethics approval

This study was presented to the Ethics Committee of the Province of Vorarlberg and does not require any referral or vote by this committee (EK-0.04-300).

Consent of participate

n/a

Consent for publication

n/a

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tschann, P., Seitinger, G., Lechner, D. et al. Reduced port versus open right hemicolectomy for colorectal cancer: a retrospective comparison study of two centers. Int J Colorectal Dis 36, 1469–1477 (2021). https://doi.org/10.1007/s00384-021-03923-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-021-03923-9

Keywords

Search

Navigation