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Comparative Study
. 2019 Apr;33(4):1020-1032.
doi: 10.1007/s00464-018-6592-3. Epub 2018 Nov 19.

Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach

Emanuele Rausa  1 , Michael Eamon Kelly  2 , Emanuele Asti  3 , Alberto Aiolfi  3 , Gianluca Bonitta  3 , Luigi Bonavina  3
Affiliations
Comparative Study

Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach

Emanuele Rausa et al. Surg Endosc. 2019 Apr.

Abstract

Background: There are a variety of surgical approaches for the management of right-sided colonic neoplasms. To date, no method has been shown superior in terms of surgical and perioperative outcomes. This meta-analysis compared open (ORH), laparoscopic-assisted (LRH), total laparoscopic (TLRH), and robotic right hemicolectomy (RRH) to assess surgical outcomes and perioperative morbidity and mortality.

Study design: We conducted an electronic systematic search using PubMed, EMBASE, and Web of Science that compared RRH, TLRH, LRH, and ORH. Forty-eight studies met the inclusion criteria: 5 randomized controlled trials, 25 retrospective, and 18 prospective studies totalling 5652 patients were included.

Results: The overall complication rate was similar between RRH and TLRH (RR 1.0; Crl 0.66-1.5). The anastomotic leak rate was higher in LRH and ORH compared to RRH (RR 1.9; Crl 0.99-3.6 and RR 1.2; Crl 0.55-2.6, respectively), whereas it was lower in TLRH compared to RRH (RR 0.88 Crl 0.41-1.9). The risk of reoperation was significantly higher in ORH compared to TLRH (RR 3.3; Crl 1.3-8.0). Operative time was similar in RRH compared to LRH (RR - 27.0; Crl - 61.0 to 5.9), and to TLRH (RR - 24.0; Crl - 70.0 to 21.0). The hospital stay was significantly longer in LRH compared to RRH (RR 3.7; Crl 0.7-6.7).

Conclusion: The surgical management of right-sided colonic disease is evolving. This network meta-analysis observed that short-term outcomes following RRH and TLRH were superior to standard LRH and ORH. The adoption of more advanced minimally invasive techniques can be costly and have associated learning phases, but will ultimately improve patient outcomes.

Keywords: Cost analysis; Laparoscopy; Postoperative complications; Right hemicolectomy; Robotic surgery.

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