Does Medial-To-Lateral Vs Lateral-To-Medial Approach Affect Short-Term Outcomes In Laparoscopic Colorectal Surgery?


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Anwar Hussain1,Andrew Torrance1,Saad Azhar1,Achillias Tsiamis1
1University Hospitals of North Midlands Stoke-on-Trent

Abstract

Background

Laparoscopic surgery is the favoured method of colorectal cancer resections. It is the surgeon’s discretion and training whether to mobilise the bowel medial-to-lateral or lateral-to-medial. Variable operating time can be multifactorial. We aim to identify the advantage of one approach over the other in terms of operating time, circumferential-resection-margins (CRM) clearance, lymph-node-harvest, and complications.

Method

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 (CRM) and lymph node harvest.

Results

137 patients with comparable demographics had laparoscopic colorectal cancer resection. 11 patients excluded (10 palliative and 1 as part of other procedure). 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. 91(71.1%) left-sided resections and 33(27.4%) right-sided resections. 54(42.2%) anterior resections and 33(26.2%) right hemi colectomies. Median operating time for anterior resections through lateral approach was 242 (134-368) minutes, while medial approach took 288(140-536) minutes, (p=0.05). 6(4.7%) cases in lateral group and 5(309%) in the medial group had positive CRM. Lateral group had on average 14(0-38) lymph nodes with specimen compared to 17(6-45) in medial group. Complications in the medial-to-lateral group were; ileus: 3 (4.8%), anastomotic leak: 1 (1.6%) and average length-of-stay: 9(2-55) days. Complications in the lateral-to-medial group were; ileus: 12(16.4%), anastomotic leak: 2 (2.7%) and average length-of-stay 7(2-75) days.

Conclusion

Our study shows that mobilising the colon medially in laparoscopic colorectal cancer resection increases the lymph node harvest and gives comparable CRM clearance. It may take longer to operate but does not increase length of hospital stay.