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Surgical Endoscopy
Published in: Surgical Endoscopy 4/2019

01-04-2019 | Review Article

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

Authors: Emanuele Rausa, Michael Eamon Kelly, Emanuele Asti, Alberto Aiolfi, Gianluca Bonitta, Luigi Bonavina

Published in: Surgical Endoscopy | Issue 4/2019

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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.
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Metadata
Title
Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach
Authors
Emanuele Rausa
Michael Eamon Kelly
Emanuele Asti
Alberto Aiolfi
Gianluca Bonitta
Luigi Bonavina
Publication date
01-04-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6592-3

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