Clinical Evaluation Of Hand-assisted Laparoscopic Hemicolectomy For Right Colon Carcinoma

ObjectiveTo study the clinical effects of hand-assisted laparoscopic hemicolectomy performed for right colon carcinoma compared to open surgery,and to evaluate its role in the treatment of right colon carcinoma.MethodsFrom January 2002 to December 2006,information was collated from theatre records, pathology records and medical notes on all patients with colonic carcinoma undergoing surgical resection.In a retrospective case-control series of right hemicolectomy,those underwent hand-assisted laparoscopic fight hemicolectomy were compared with an age-matched,tumor pathology-matched and stage-matched series of patients who underwent open surgery.Choice of operation approaches was according to patients' willing.In additional to avoid the influence of body weight to evaluate therapy outcomes,patients were classified as normal weight and obesity according to adult body weight classification.Cases of Dukes staging D,emergency operations,previous abdominal surgery or salvage therapy were excluded.Evaluation factors included:operative time,blood loss,length of specimen resection,clearance of lymph nodes,postoperative short-term recovery outcomes,incidences of postoperative complications,body stress reaction and hospitalized costs,et al.ResultsA total of resected right colonic carcinoma patients were identified in the study,mean age of A1(54±5) years,A2(55±4) years,B1(55±5) years,B2(53±4) years;male 42cases,female 54 cases.Patten of pathology was defined as adenocarcinoma,low, moderate and high differentiation were 27,28,41,respectively.Dukes A,B,C staging was 15,54,27,respectively.There were no significant differences in terms of median operative time,blood loss,length of specimen excision,clearance of lymph nodes, and incidence rates of complication in patients of normal weight between hand-assisted laparoscopic group and the open group.There were also no differences in obesity patients between both groups,except blood loss was less in laparoscopic group than in the open group.In patients of normal weight,differences in temperature recovery time,median days to motion out of bed,hospital days,were not significant between two groups.However,laparoscopic group was associated with shorter time to diet and to pass flatus than open group.In obesity patients,laparoscopic group was associated with earlier recovery to normal temperature,earlier return to out of activity, and shorter hospital stay compared to open group.Plasma levels of IL-6,CRP,ACTH and cortisol significantly increased after operation in patients of normal weight of both groups,while no differences were found between the two groups.In obesity patients,there were an increase in plasma level of IL-6, CRP,ACTH and cortisol after operation in both groups,while a more evident increase was found in the open group.In patients of normal weight,laparoscopic group required more operation costs and hospitalized costs than open group.In obesity patients,laparoscopic group needed more operation costs than the open group,however,hospitalized costs of both groups are comparable.ConclusionsIn conclusion,this study has shown no evidence of any alteration in the pattern of short-term outcomes after hand-assisted laparoscopic and conventional surgery for right colonic carcinoma in patients of normal weight.Admittedly,hand-assisted laparoscopic hemicoletomy is a safe option for obesity patients and is associated with more favorable short-term outcomes in terms of rapidly return of bodily function, shorten hospital stay,less costs and stress reaction,playing an important role in clinical application with its minimally invasive characters.