Impact of medial-to-lateral vs lateral-to-medial approach on short-term and cancer-related outcomes in laparoscopic colorectal surgery: A retrospective cohort study. (February 2018)

• Record Type: Journal Article
• Authors: Hussain, Anwar; Mahmood, Fahad; Torrance, Andrew W.; Tsiamis, Achilleas
• Is Part Of: Annals of medicine and surgery. Volume 26(2018)
• Page Start: 19
• Page End: 23
• Publication Date: 2018-02
• Subjects: Colorectal cancer -- Method of surgery -- Lateral mobilisation -- Mesocolon -- Medial mobilisation -- survival; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2017.12.011
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: Laparoscopic surgery is the favoured method of colorectal cancer resections. It is surgeon expertise and discretion to choose whether to mobilize colon lateral-to-medial or medial-to-lateral. We aim to identify the advantage of one approach over the other in short-term and cancerrelated outcomes. Methods: A retrospective review of a prospectively maintained database of all laparoscopic colorectal resections with curative-intent, in a single unit, from March 2013 to October 2014. Data was collected on patient demographics, method of laparoscopic mobilisation, operating time, length-of-stay, post-operative complications, clearance of circumferential resection margins lymph node harvest and follow-up. Results: 137 patients with comparable patient demographics had laparoscopic colorectal cancer resection. 76 (60.3%) male and 50 (39.7%) female patients. 58(46.0%) of resections were performed using medial-to-lateral approach, while 68(54.0%) lateral-to-medial. Lateral group had on average 14(0–38) lymph nodes with specimen compared to 17 (6–45) in medial group. There was a statistically significant difference in the major complication rate (Clavien-Dindo IV) between the groups with 1(1.7%) in the medial-to-lateral group compared to 7 (10.2%) in the lateral-to-medial group, (p .035). Patients in the medial-to-lateral group had median length-of-stay of 7 days (range 2–55) compared to 7 days (range 2–75) in the lateral-to-medial group. There was no statistically significant difference in survival between both groups up-to 1334 days p=.413. Conclusion: Our study shows that mobilising the colon medially in laparoscopic colorectal cancer resection increases the lymph node harvest, gives comparable CRM clearance, similar length of hospital stay and complications. It makes no statistically significant difference in the overall patient survival. Highlights: This study reports that no one approach is superior to the other but the patient having surgery using medial-to-lateral approach have less post operative complications and higher number of lymph node harvest. There is no long-term advantage to report. Meta-analysis by Ding and colleagues reported that medial-to-lateral approach is better in terms of conversion rate and complications but give less number of lymph nodes in the specimen.