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International Journal of Colorectal Disease

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01-05-2019 | Wound Infection | Review

Meta-analysis of medial-to-lateral versus lateral-to-medial colorectal mobilisation during laparoscopic colorectal surgery

Authors: Shahin Hajibandeh, Shahab Hajibandeh, Ahmad Navid, Diwakar Ryali Sarma, Mokhtar Eltair, Rajnish Mankotia, Christopher Vaun Thompson, Andrew W. Torrance, Rajeev Peravali

Published in: International Journal of Colorectal Disease | Issue 5/2019

Abstract

Objectives

To evaluate comparative outcomes of medial-to-lateral and lateral-to-medial colorectal mobilisation in patients undergoing laparoscopic colorectal surgery.

Methods

We conducted a systematic search of electronic databases and bibliographic reference lists. Perioperative mortality and morbidity, procedure time, length of hospital stay, rate of conversion to open procedure, and number of harvested lymph nodes were the outcome parameters. Combined overall effect sizes were calculated using fixed-effects or random-effects models.

Results

We identified eight comparative studies reporting a total of 1477 patients evaluating outcomes of medial-to-lateral (n = 626) and lateral-to-medial (n = 851) approaches in laparoscopic colorectal resection. The medial-to-lateral approach was associated with significantly lower rate of conversion to open (odds ratio (OR) 0.43, P = 0.001), shorter procedure time (mean difference (MD) − 32.25, P = 0.003) and length of hospital stay (MD − 1.54, P = 0.02) compared to the lateral-to-medial approach. However, there was no significant difference in mortality (risk difference (RD) 0.00, P = 0.96), overall complications (OR 0.78, P = 0.11), wound infection (OR 0.84, P = 0.60), anastomotic leak (OR 0.70, P = 0.26), bleeding (OR 0.60, P = 0.50), and number of harvested lymph nodes (MD − 1.54, P = 0.02) between two groups. Sub-group analysis demonstrated that the lateral-to-medial approach may harvest more lymph nodes in left-sided colectomy (MD − 1.29, P = 0.0009). The sensitivity analysis showed that overall complications were lower in the medial-to-lateral group (OR 0.72, P = 0.49).

Conclusions

Our meta-analysis (level 2 evidence) showed that medial-to-lateral approach during laparoscopic colorectal resection may reduce procedure time, length of hospital stay and conversion to open procedure rate. Moreover, it may probably reduce overall perioperative morbidity. However, both approaches carry similar risk of mortality, and have comparable ability to harvest lymph nodes. Future high-quality randomised trials are required.

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Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surgical Laparoscopy & Endoscopy 1:144–150

Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059CrossRefPubMed

Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52CrossRefPubMed

Fujii S, Tsukamoto M, Fukushima Y, Shimada R, Okamoto K, Tsuchiya T, Nozawa K, Matsuda K, Hashiguchi Y (2016 Jul 15) Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients. World J Gastrointest Oncol 8(7):573–582CrossRefPubMedPubMedCentral

Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J (2008) Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 143:762–767CrossRefPubMed

Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91CrossRefPubMedPubMedCentral

Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Color Dis 8:375–388CrossRef

Milsom JW, Böhm B, Decanini C, Fazio VW (1994) Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model. Surg Endosc 8(9):1117–1123CrossRefPubMed

Milsom JW, Böhm B, Hammerhofer KA, Fazio V, Steiger E, Elson P (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187(1):46–54CrossRefPubMed

10.

Hoffman GC, Baker JW, Fitchett CW, Vansant JH (1994) Laparoscopic-assisted colectomy. Initial experience Ann Surg 219(6):732–740PubMed

11.

Elftmann TD, Nelson H, Ota DM, Pemberton JH, Beart RW Jr (1994) Laparoscopic-assisted segmental colectomy: surgical techniques. Mayo Clin Proc 69(9):825–833CrossRefPubMed

12.

Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL, European Association of Endoscopic Surgery (EAES) (2004) European Association of Endoscopic Surgery (EAES) laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18:1163–1185CrossRefPubMed

13.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 339:b2700CrossRefPubMedPubMedCentral

14.

Higgins JP, Altman DG, editors. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.0.1 [updated September 2008]. Available at: http://hiv.cochrane.org/sites/hiv. cochrane.org/files/uploads/Ch08_Bias.pdf. Accessed November 28, 2018

15.

Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/ programs/clinical_epidemiology/oxford.asp. November 28, 2018

16.

Liang JT, Lai HS, Huang KC, Chang KJ, Shieh MJ, Jeng YM, Wang SM (2003) Comparison of medial-to-lateral versus traditional lateral-to-medial laparoscopic dissection sequences for resection of rectosigmoid cancers: randomized controlled clinical trial. World J Surg 27:190–196CrossRefPubMed

17.

Rotholtz NA, Bun ME, Tessio M, Lencinas SM, Laporte M, Aued ML, Peczan CE, Mezzadri NA (2009) Laparoscopic colectomy: medial vs lateral approach. Surg Laparosc Endosc Percutan Tech 19:43–47CrossRefPubMed

18.

Poon JT, Law WL, Fan JK, Lo OS (2009) Impact of the standardized medial-to-lateral approach on outcome of laparoscopic colorectal resection. World J Surg 33:2177–2182CrossRefPubMed

19.

Day W, Lau PY (2010) Impact of the standardized medial-to-lateral approach on outcome of laparoscopic colorectal resection. Is it a fair comparison? World J Surg 34:1146–1147CrossRefPubMed

20.

Yan J, Ying MG, Zhou D, Chen X, Chen LC, Ye WF et al (2010) A prospective randomized control trial of the approach for laparoscopic right hemi-colectomy: medial-to-lateral versus lateral-to-medial. Chin J Gastrointest Surg 13:403

21.

Kim HJ, Kim CH, Lim SW, Huh JW, Kim YJ, Kim HR (2013) An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection. Color Dis 15(2):e93–e98CrossRef

22.

Honaker M, Scouten S, Sacksner J, Ziegler M, Wasvary H (2016) A medial to lateral approach offers a superior lymph node harvest for laparoscopic right colectomy. Int J Color Dis 31(3):631–634CrossRef

23.

Hussain A, Mahmood F, Torrance AW, Tsiamis A (2017) Impact of medial-to-lateral vs lateral-to-medial approach on short-term and cancer-related outcomes in laparoscopic colorectal surgery: A retrospective cohort study. Ann Med Surg (Lond) 26:19–23CrossRef

24.

Ding J, Liao GQ, Xia Y, Zhang ZM, Pan Y, Liu S (2013) Medial versus lateral approach in laparoscopic colorectal resection: a systematic review and meta-analysis. World J Surg 37(4):863–872CrossRefPubMed

25.

Hozo S, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13CrossRefPubMedPubMedCentral

Title: Meta-analysis of medial-to-lateral versus lateral-to-medial colorectal mobilisation during laparoscopic colorectal surgery
Authors: Shahin Hajibandeh
Shahab Hajibandeh
Ahmad Navid
Diwakar Ryali Sarma
Mokhtar Eltair
Rajnish Mankotia
Christopher Vaun Thompson
Andrew W. Torrance
Rajeev Peravali
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Keywords: Wound Infection
Colectomy
Colectomy
Published in: International Journal of Colorectal Disease / Issue 5/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-019-03281-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Meta-analysis of medial-to-lateral versus lateral-to-medial colorectal mobilisation during laparoscopic colorectal surgery

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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