Medial to lateral VS lateral to medial in laparoscopic right hemicolectomy-are both techniques the same?

Abstract

Abstract Purpose we compare MtL to LtM surgical approach for laparoscopic right hemicolectomy, with regards to number of lymph node harvested, operation duration, and length of hospitalization (LOH). Methods A retrospective analysis of patients who underwent laparoscopic right hemicolectomy resections for malignant neoplasms, curative-intent, between 2013 to 2020 at Edith Wolfson Medical Center. Surgical techniques were defined as Medial to lateral if the first stage included blood vessel ligation. Lateral to Medial was defined if the first step included mobilization of the lateral attachments. Results 133 patients who were diagnosed with colon cancer (mean age 72 ± 5.8 years, 46% males) were selected for laparoscopic right hemicolectomy. 54 were treated with the MtL approach, and 79 were treated with the LtM approach. Lymph nodes harvested were similar between the 2 groups (mean of 17, SD +-11). LOH and time of first flatulence were similar between the groups (11.78 ± 1.8 for the LtM group vs. 10.56 ± 1.4 for the MtL group for LOH, and 3.75 ± 0.8 days for the LtM group vs. 4 ± 0.9 days for the MtL group for time of first flatulence, p = 0.30 and p = 0.69 respectively). No difference in patient's survival rate within 30 days. Patients after LtM approach had a shorter operation time (2.18H). Conclusion The laparoscopic approach performing right hemicolectomy resection can be performed safely with the same results using the two methods compared. It showed no oncological benefits, and no significant differences in the LOH or short term survival. The LtM approach was associated with a shorter surgery time.