Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Oct 5;4(4):e343.
doi: 10.1097/AS9.0000000000000343. eCollection 2023 Dec.

Best Evidence for Each Surgical Step in Minimally Invasive Right Hemicolectomy: A Systematic Review

Alexander A J Grüter  1   2 , Julie M L Sijmons  3   4 , Usha K Coblijn  1 , Boudewijn R Toorenvliet  5 , Pieter J Tanis  3   6 , Jurriaan B Tuynman  1
Affiliations
Review

Best Evidence for Each Surgical Step in Minimally Invasive Right Hemicolectomy: A Systematic Review

Alexander A J Grüter et al. Ann Surg Open. .

Abstract

Objective: The aim of this study was to systematically review the literature for each surgical step of the minimally invasive right hemicolectomy (MIRH) for non-locally advanced colon cancer, to define the most optimal procedure with the highest level of evidence.

Background: High variability exists in the way MIRH is performed between surgeons and hospitals, which could affect patients' postoperative and oncological outcomes.

Methods: A systematic search using PubMed was performed to first identify systematic reviews and meta-analyses, and if there were none then landmark papers and consensus statements were systematically searched for each key step of MIRH. Systematic reviews were assessed using the AMSTAR-2 tool, and selection was based on highest quality followed by year of publication.

Results: Low (less than 12 mmHg) intra-abdominal pressure (IAP) gives higher mean quality of recovery compared to standard IAP. Complete mesocolic excision (CME) is associated with lowest recurrence and highest 5-year overall survival rates, without worsening short-term outcomes. Routine D3 versus D2 lymphadenectomy showed higher LN yield, but more vascular injuries, and no difference in overall and disease-free survival. Intracorporeal anastomosis is associated with better intra- and postoperative outcomes. The Pfannenstiel incision gives the lowest chance of incisional hernias compared to all other extraction sites.

Conclusion: According to the best available evidence, the most optimal MIRH for colon cancer without clinically involved D3 nodes entails at least low IAP, CME with D2 lymphadenectomy, an intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision.

Keywords: colon cancer; laparoscopic; minimally invasive; right hemicolectomy; right-sided colon cancer; robot-assisted; surgical steps.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors declare that they have nothing to disclose.

Figures

FIGURE 1.
FIGURE 1.
The schematic overview showing the difference of complete mesocolic excision (CME), central vascular ligation (CVL), ‘optimal D2’, and D3 dissection.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Aguiar Junior S, Oliveira MM, Silva DRME, et al. . Survival of patients with colorectal cancer in a cancer center. Arq Gastroenterol. 2020;57:172–177. - PubMed
    1. van der Pas MH, Haglind E, Cuesta MA, et al. ; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–218. - PubMed
    1. Bonjer HJ, Deijen CL, Abis GA, et al. ; COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372:1324–1332. - PubMed
    1. Lei X, Wang Y, Shan F, et al. . Short-and long-term outcomes of laparoscopic versus open gastrectomy in patients with gastric cancer: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol. 2022;20:405. - PMC - PubMed
    1. Jamali FR, Soweid AM, Dimassi H, et al. . Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg. 2008;143:762–7; discussion 768. - PubMed