Short-term And Long-term Outcomes Of Three-port Laparoscopic Right Hemi-colectomy Versus Five-port Laparoscopic Right Hemi Colectomy: With A Propensity Score Matching Analysis

Chapter 1 The short-term outcomes of the TPLRC and TLRC1.Purpose The aim of this chapter is to prove the safety,radicality and feasibility of TPLRC(Three-port laparoscopic right hemi-colectomy)through the comparsion of short-term outcomes of TPLRC and TLRC(Five-port laparoscopic right hemi-colectomy).2.Methods 192 patients were involved in this study.The patients who went over TPLRC or TLRC in Shanghai minimally invasive center from September 2012 to November were non-randomized selected and analyzed retrospectively.In order to eliminate the select bias,propensity score matching(PSM)were utilized in this study according to the patient's characteristics like age,sex,BMI,etc.3.Results After PSM,there were 62 patients in both TPLRC and TLRC group.The mean operative time of TPLRC group was significantly shorter than TLRC group(142.75±30.57 vs.155.27±36.23 min,p=0.040).A lower blood loss was observed in TPLRC group without statistical difference(82.90±87.68 vs.111.40±97.41 ml,p=0.089).And there was no sigificant difference of number of harvested lymph nodes between two groups(18.61±7.06 vs.16.95±7.14,p=0.195).No statistical difference in other short-term outcomes between TPLRC and TLRC.4.Conclusion TPLRC is a safe and feasible surgical procedure with similar results of TLRC in short-term and long-term clinical outcomes.TPLRC has the superiority of the operative time,less surgeon necessity,lower cost of surgery.Chapter 2 Long-term outcomes of the TPLRC and TLRC and the multi-factor risk analysis1.Purpose The purpose of this chapter is to compare the long-term outcomes of TPLRC and FPRLC,and to conduct a mult-factor risk analysis of the related recurrence and metastasis factors in the right colon cancer.2.Methods 164 patients were involved in the first chapter.The patients who went over TPLRC or TLRC in Shanghai minimally invasive center from September 2012 to November were non-randomized selected and analyzed retrospectively.The long-term outcomes of TPLRC and TLRC was compared using kplan-meier survival analysis and log-rank test by recording patients' recurrence,metastasis and survival status through telephone and outpatient follow-up.Univariate and multivariate cox analysis was used to analyze the independent prognostic factors of postoperative recurrence and metastasis of right colon cancer.3.Results A total of 13 patients in the TPLRC group relapsed,and 12 patients in the FPRLC group relapsed.There was no statistical difference in the recurrence rate between the two groups.There was no statistical difference in 3-year DFS rate between the two groups(79.0% vs.82.3%,P=0.649),nor in 3-year OS rate(91.3% vs.88.7%,P=0.544).After cox analysis of factors related to recurrence and metastasis of right colon cancer,degree of differentiation(P=0.028)was an independent risk factor for postoperative recurrence and metastasis of right colon cancer,and age over 65(P=0.025)was an independent protective factor for postoperative recurrence and metastasis of right colon cancer.4.Conclusion There was no statistically significant difference between TPLRC and TLRC groups in long-term postoperative follow-up results.Recurrence and metastasis of right colon cancer were highly correlated with tumor differentiation and patient age.