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Published in: International Journal of Colorectal Disease 1/2012

01-01-2012 | Original Article

Laparoscopic-assisted versus open resection of right-sided colonic cancer—a prospective randomized controlled trial

Authors: Jimmy Chak-Man Li, Ka Lau Leung, Simon Siu-Man Ng, Shirley Yuk-Wa Liu, Janet Fung-Yee Lee, Sophie Sok-Fei Hon

Published in: International Journal of Colorectal Disease | Issue 1/2012

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Abstract

Purposes

This study aims to compare the perioperative outcomes and survival between laparoscopic-assisted right hemicolectomy (LARH) and open right hemicolectomy (ORH) for right-sided colon cancer.

Methods

Between July 1996 and October 2005, 145 patients were randomized to receive LARH (n = 71) or ORH (n = 74).

Results

The median follow-up of living patients was 99.7 months. The demographic data of the two groups were similar. The time to resume diet (4 vs. 5 days, p = 0.045) and the hospital stay (7.8 vs. 10 days, p = 0.033) were significantly shorter in LARH group, but these benefits were at the expense of longer operating time (198 vs. 129 min, p = 0.002) and higher direct cost (USD8745 vs. USD6293, p < 0.001). The morbidity and mortality were comparable between the two groups. After curative resection, the probabilities of survival at 5 years of the LARH and ORH groups were 74.2% (SE 7.4%) and 75% (SE 7.1%), respectively. The probabilities of being disease free at 5 years were 82.3% (SE 6.9%) and 84.1% (SE 6.2%), respectively.

Conclusions

Laparoscopic-assisted resection of right-sided colonic cancer has the advantage over open surgery in allowing earlier recovery. However this is at the expense of a longer operating time and higher direct cost (registration number: NCT00485316 (http://​www.​clinicaltrials.​gov)).
Literature
2.
go back to reference Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef
3.
go back to reference Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, The Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study trial group. Ann Surg 246:655–664PubMedCrossRef Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, The Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study trial group. Ann Surg 246:655–664PubMedCrossRef
4.
go back to reference Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Colon Cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 6:477–484PubMedCrossRef Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Colon Cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 6:477–484PubMedCrossRef
5.
go back to reference Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial)—multicentre, randomized controlled trial. Lancet 365:1718–1726PubMedCrossRef Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial)—multicentre, randomized controlled trial. Lancet 365:1718–1726PubMedCrossRef
6.
go back to reference Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20:CD003145 Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20:CD003145
7.
go back to reference Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192PubMedCrossRef Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192PubMedCrossRef
8.
go back to reference Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15(9):2418–2425PubMedCrossRef Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15(9):2418–2425PubMedCrossRef
9.
go back to reference Leung KL, Meng WC, Lee JF, Thung KH, Lai PB, Lau WY (1999) Laparoscopic-assisted resection of right-sided colonic carcinoma: a case–control study. J Surg Oncol 71:97–100PubMedCrossRef Leung KL, Meng WC, Lee JF, Thung KH, Lai PB, Lau WY (1999) Laparoscopic-assisted resection of right-sided colonic carcinoma: a case–control study. J Surg Oncol 71:97–100PubMedCrossRef
10.
go back to reference Baker RP, Titu LV, Hartley JE, Lee PW, Monson JR (2004) A case–control study of laparoscopic right hemicolectomy vs. open right hemicolectomy. Dis Colon Rectum 47:1675–1679PubMedCrossRef Baker RP, Titu LV, Hartley JE, Lee PW, Monson JR (2004) A case–control study of laparoscopic right hemicolectomy vs. open right hemicolectomy. Dis Colon Rectum 47:1675–1679PubMedCrossRef
11.
go back to reference Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM (2005) Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 11:323–326PubMed Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM (2005) Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 11:323–326PubMed
12.
go back to reference Lohsiriwat V, Lohsiriwat D, Chinswangwatanakul V, Akaraviputh T, Lert-Akyamanee N (2007) Comparison of short-term outcomes between laparoscopically-assisted vs. transverse-incision open right hemicolectomy for right-sided colon cancer: a retrospective study. World J Surg Oncol 5:49PubMedCrossRef Lohsiriwat V, Lohsiriwat D, Chinswangwatanakul V, Akaraviputh T, Lert-Akyamanee N (2007) Comparison of short-term outcomes between laparoscopically-assisted vs. transverse-incision open right hemicolectomy for right-sided colon cancer: a retrospective study. World J Surg Oncol 5:49PubMedCrossRef
13.
go back to reference Tong DK, Law WL (2007) Laparoscopic versus open right hemicolectomy for carcinoma of the colon. JSLS 11:76–80PubMed Tong DK, Law WL (2007) Laparoscopic versus open right hemicolectomy for carcinoma of the colon. JSLS 11:76–80PubMed
14.
go back to reference Ng SS, Lee JF, Yiu RY, Li JC, Leung WW, Leung KL (2008) Emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right-sided colonic carcinoma: a comparative study of short-term clinical outcomes. World J Surg 32:454–458PubMedCrossRef Ng SS, Lee JF, Yiu RY, Li JC, Leung WW, Leung KL (2008) Emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right-sided colonic carcinoma: a comparative study of short-term clinical outcomes. World J Surg 32:454–458PubMedCrossRef
15.
go back to reference Tan WS, Chew MH, Ooi BS, Ng KH, Lim JF, Ho KS, Tang CL, Eu KW (2009) Laparoscopic versus open right hemicolectomy: a comparison of short-term outcomes. Int J Colorectal Dis 24:1333–1339PubMedCrossRef Tan WS, Chew MH, Ooi BS, Ng KH, Lim JF, Ho KS, Tang CL, Eu KW (2009) Laparoscopic versus open right hemicolectomy: a comparison of short-term outcomes. Int J Colorectal Dis 24:1333–1339PubMedCrossRef
16.
go back to reference Nakamura T, Onozato W, Mitomi H, Naito M, Sato T, Ozawa H, Hatate K, Ihara A, Watanabe M (2009) Retrospective, matched case–control study comparing the oncologic outcomes between laparoscopic surgery and open surgery in patients with right-sided colon cancer. Surg Today 39:1040–1045PubMedCrossRef Nakamura T, Onozato W, Mitomi H, Naito M, Sato T, Ozawa H, Hatate K, Ihara A, Watanabe M (2009) Retrospective, matched case–control study comparing the oncologic outcomes between laparoscopic surgery and open surgery in patients with right-sided colon cancer. Surg Today 39:1040–1045PubMedCrossRef
17.
go back to reference Greene FLP, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual, 6th edn. Springer, Philadelphia Greene FLP, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M (2002) AJCC cancer staging manual, 6th edn. Springer, Philadelphia
18.
go back to reference Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891PubMedCrossRef Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891PubMedCrossRef
19.
go back to reference Scatizzi M, Kroning KC, Borrelli A, Andan G, Lenzi E, Feroci F (2010) Extracorporeal versus intracorporeal anastomosis after laparoscopic right colectomy for cancer: a case–control study. World J Surg 34:2902–2908PubMedCrossRef Scatizzi M, Kroning KC, Borrelli A, Andan G, Lenzi E, Feroci F (2010) Extracorporeal versus intracorporeal anastomosis after laparoscopic right colectomy for cancer: a case–control study. World J Surg 34:2902–2908PubMedCrossRef
20.
go back to reference Hellan M, Anderson C, Pigazzi A (2009) Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS 13:312–317PubMed Hellan M, Anderson C, Pigazzi A (2009) Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS 13:312–317PubMed
21.
go back to reference Basse L, Hjort Jakobsen D, Billesbølle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232:51–57PubMedCrossRef Basse L, Hjort Jakobsen D, Billesbølle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232:51–57PubMedCrossRef
22.
go back to reference King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308PubMedCrossRef King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308PubMedCrossRef
23.
go back to reference Stead ML, Brown JM, Bosanquet N, Franks PJ, Guillou PJ, Quirke P, Jayne D, Monson JR, Webb AV (2000) Assessing the relative costs of standard open surgery and laparoscopic surgery in colorectal cancer in a randomised controlled trial in the United Kingdom. Crit Rev Oncol Hematol 33:99–103PubMedCrossRef Stead ML, Brown JM, Bosanquet N, Franks PJ, Guillou PJ, Quirke P, Jayne D, Monson JR, Webb AV (2000) Assessing the relative costs of standard open surgery and laparoscopic surgery in colorectal cancer in a randomised controlled trial in the United Kingdom. Crit Rev Oncol Hematol 33:99–103PubMedCrossRef
24.
go back to reference Li JC, Lee JF, Ng SS, Yiu RY, Hon SS, Leung WW, Leung KL (2010) Conversion in laparoscopic-assisted colectomy for right colon cancer: risk factors and clinical outcomes. Int J Colorectal Dis 25:983–988PubMedCrossRef Li JC, Lee JF, Ng SS, Yiu RY, Hon SS, Leung WW, Leung KL (2010) Conversion in laparoscopic-assisted colectomy for right colon cancer: risk factors and clinical outcomes. Int J Colorectal Dis 25:983–988PubMedCrossRef
25.
go back to reference Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52PubMedCrossRef Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52PubMedCrossRef
26.
go back to reference Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRef Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRef
27.
go back to reference Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645PubMedCrossRef Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645PubMedCrossRef
Metadata
Title
Laparoscopic-assisted versus open resection of right-sided colonic cancer—a prospective randomized controlled trial
Authors
Jimmy Chak-Man Li
Ka Lau Leung
Simon Siu-Man Ng
Shirley Yuk-Wa Liu
Janet Fung-Yee Lee
Sophie Sok-Fei Hon
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 1/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-011-1294-5

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