Comparison of clinical efficacy between bursa omentalis approach and medial-to-lateral approach in laparoscopic left hemicolectomy: a propensity score matching analysis / 中华胃肠外科杂志

Objective: Splenic flexure mobilization is technically difficult during the resection of left hemicolon cancer. This study aims to compare the safety and effectiveness between the bursa omentalis approach (BOA) and medial-to-lateral approach (MTLA) in laparoscopic radical resection of left-sided colon cancer. Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) patients underwent radical resection of left hemicolon cancer; (2) the postoperative pathological result was adenocarcinoma; (3) patients aged 18-80 years old; (4) no liver, peritoneal or other distant metastasis. Exclusion criteria: (1) poor physical condition with serious heart, brain, lung, liver, kidney and hematopoietic system diseases; (2) unable to tolerate laparoscopic surgery; (3) history of other malignancies simultaneously, or multisource tumors; (4) emergency operation due to bleeding, obstruction, perforation, etc. Clinical data of 189 patients who underwent laparoscopic left hemicolectomy in the Guangdong Provincial Hospital of Chinese Medicine from 2014 to 2020 were retrospectively analyzed. According to surgical approaches, patients were divided into the BOA group (52 cases) and MTLA group (137 cases). The whole group of patients were matched by propensity score matching (PSM) according to the nearest neighbor matching method. The caliper value was 0.01. The matching variables included gender, age, American Society of Anesthesiologists (ASA) score, body mass index, tumor location and tumor stage. After PSM, 47 patients were included in the BOA group and MTLA group, respectively. There were no significant differences in baseline data between the two groups after PSM (all P>0.05). Paired t-test, paired rank sum test and paired Chi-square test were used to compare intraoperative and postoperative paramether between the two groups. Kaplan-Meier method was used to draw the survival curve, and log rank test was used for inter group comparison. When the two survival curves intersect, the two-stage method and restricted mean survival time (RMST) were further performed. Results: Both groups of patients successfully completed the operation without conversion to laparotomy or intraoperative death. No combined splenectomy or pancreatectomy were performed in the two groups. There were also no significant differences in intraoperative blood loss, number of harvested lymph nodes, time to the first flatus and the length of hospital stay between the two groups (all P>0.05). However, the median laparoscopic dissection time in the BOA group was shorter than that in the MTLA group, and the difference was statistically significant (median: 56 minutes vs. 65 minutes, P=0.032). No entry to posterior pancreatic space was recorded in the BOA group but wrong entry to posterior pancreatic space happened to 6.4% (3/47) of patients (body mass index >25 kg/m(2)) when dissecting left Toldt's fascia in the MTLA group. The 3-year disease-free survival rate in BOA group and MTLA group was 90.2% and 86.1%, respectively (P=0.909) and the 3-year overall survival rate was 85.6% and 94.4%, respectively (P=0.532). Conclusions: BOA is safe and feasible in laparoscopic left hemicolectomy, especially for inexperienced surgeons. For obese patients, BOA facilitates the entrance into the correct anatomical level and avoid entering the retropancreatic space.

Clinical Contrastive Study between Caudal-to-crainal and Medial-to-lateral Approaches for Laparoscopic Right Hemicolectomy / 昆明医科大学学报

Objective To compare the short-term therapeutic effects of the caudal-to-crainal and medial-to-lateral approaches for laparoscopic right hemicolectomy. Method The clinical data of 124 patients underwent laparoscopic right hemicolectomy in the department of gastrointestinal surgery, the First Affiliated Hospital of Kunming Medical Universitiy from,June 2014 to June 2016,were analyzed retrospectively. According the surgical operation, the patients were divided into two groups,caudal-to-crainal group with 48 patients,and medial-to-lateral group with 76 patients. The characteristics, opertation time, volum of blood loss during operation, the number of lymph node dissection, the rate of conversion to laparotomy,postoperative eating time, postoperative ventilation time, postoperative hospital stay time, postoperative complications of the two groups were analyzed to compare the short-term therapeutic effects. Result No significant differences were found in the sexual distinction, age, BMI,the volume blood loss during the operation, the number of lymph node dissection, the rate of conversion to laparotomy, postoperative eating time, postoperative ventilation time, postoperative hospital stay time, postoperative complications between the two groups (P＞0.05).Significant differences were found in the operation time [caudal-to-crainal group vs medial-to-lateral group (123.49 ±14.19 min VS 140.57 ±25.40 min) ] and the blood loss of the operation [caudal-to-crainal group vs medial-to-lateral group (60.63±24.00 ml vs 77.24 ±36.90 ml) ]. Conclusion The caudal-to-crainal approach for laparoscopic right hemicolectomy is more simple, practicable, with less blood loss during the operation and safer, which worth being recommended in right-hemicolectom-surgery.