Totally laparoscopic right colectomy versus laparoscopically assisted right colectomy: a propensity score analysis

Abstract

Introduction: The aim of this study is to compare short- and long-term outcomes of totally laparoscopic right colectomy (TLRC) and laparoscopically assisted right colectomy (LARC), using propensity score matching (PSM) analysis.

Materials and methods: A retrospective analysis of patients who underwent laparoscopic right colectomy between January 2006 and July 2016 was conducted. PSM analysis was performed to overcome patient selection bias between the two surgical techniques.

Results: A total of 116 patients were reviewed. After PSM, 54 patients for the TLRC group and 54 patients for the LARC group were compared. TLRC was associated with shorter post-operative hospital stay (6.81 vs. 4.79 days; p < 0.001) with no difference in 30-day morbidity and mortality. A lower incidence of long-term incisional hernia was observed in the TLRC group (1.9 vs. 21.2%; p = 0.002). TLRC showed better oncological accuracy as demonstrated by a greater number of lymph node achieved (19.21 vs. 15.19; p = 0.001) and higher vascular pedicle length (131.81 vs. 114.76 mm; p = 0.014).

Discussion: TLRC is a safe and feasible technique with similar results of LARC in terms of short-term morbidity and mortality. Major advantages related to TLRC are represented by shorter post-operative hospital stay and lower incidence of long-term incisional hernias. Further investigations are needed to assess the oncological outcomes for this technique.

Keywords: Incisional hernia; Intracorporeal anastomosis; Laparoscopy; Propensity score matching; Right colectomy.