Laparoscopic versus Open Right Hemicolectomy : A single centre experience

M A Gok, S J Ward, M M Sadat, U A Khan. Macclesfield District General Hospital

Intoduction Colorectal cancer is the 3rd most commonest maligancy in men & woemn in the UK. representing 13% of all new cancers in 2010. Right sided cancers (appendic, caecum, ascending & transverse colon) contribute to a 3rd of colorectal maligancies. The aim of the study is to assess right hemicoloectomies carried out at a district general hospital.

Materials & Methods This is a retospective study carried out since 2008 at Macclesfiedl District Genereal Hospital. Descriptive demography, co-morbidities,histopathology & surgical outcomes were evaluated for all right hemicolectomies (laparoscopic, open & emergency cases).

Discussion Laparoscopic Rt Hemi has advantage of minimal invasion, earlier recovery, lowere rates of wound complications, shorter hospital stay & comparable survival rates of Open Rt Hemi. The prolonged operative time is attributed to the use of laparoscopy. Em Rt Hemi had a poorer survival as patients were generally ill (ASA 3) with sepsis.

Results
Lap Rt Hemi (n=93) Open Rt Hemi (n=118) Em Rt Hemi (n =75) Kruskal-Wallis test (p value)
Age (yrs) 74.8 72.3 70.0 NS
Sex (M : F) 41 : 52 67 : 51 33 : 42 NS
ASA 2 2 3 < 0.05
Weight (kg) 67.6 80.4 68.6 < 0.05
BMI 24.5 27.0 25.0 < 0.05
Appendix/Ileum 1 2 1
Caecum 51 60 32
Ascending colon 22 23 12
Transverse colon 19 33 30
Op time (min) 145.8 107.1 118.6 < 0.05
LN harvest (n) 16 16.5 14 NS
Diverticulosis (n) 14 14 13 NS
Synchronous tumours (n) 10 31 9 < 0.05
LOS (days) 7 9 11 < 0.05
small bowel length (mm) 92.2 92.7 124.1 < 0.05
large bowel length (mm) 218.5 231.8 309.5 NS
1st year survival 95.1 90.5 73.7 logrank p < 0.05
3rd year survival 82.2 76.5 49.9 logrank p < 0.05
5th year survival 69.4 71.7 45.4 logrank p < 0.05

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