Totally Laparoscopic Versus Laparoscopic-assisted Right Hemicolectomy For Right Hemicolon Carcinoma:A Meta-analysis

Objective:The aim of the study was to compare the efficacy,advantages or disadvantages between totally laparoscopic and laparoscopic-assisted right hemicolectomy for right hemicolon carcinoma by meta-analysis.Methods:The literatures comparing totally laparoscopic(TLC)and laparoscopic-assisted colectomy(LAC)for right hemicolon carcinoma from January 1991 to December2015 were searched from Pubmed,Elsevier,Cochrane Library,SPRINGER,CNKI,Wanfang,Chinese biological and medical database.The established inclusion and exclusion criteria was used to screening literatures.Then data extraction and quality assessment were carried out.The outcome variables were hospital stay,first flatus time,incision length,operative time,number of lymph nodes obtained,blood loss,mortality,reintervention,duration of postoperative analgesia treatment,conversion to laparotomy,postoperative complications.The meta-analysis was conducted by the Review Manager 5.3.Results:There were twelve literatures comprising 1428 patients(739 in TLC and 689 in LAC)in this analysis.Compared to LAC,TLC for right hemicolon carcinoma resulted in shorter first flatus time(WMD=-0.50,95%CI:-0.76~-0.24,P=0.0001),shorter hospital stay(WMD=-1.02,95%CI:-1.95~-0.46,P=0.002),shorter incision length(WMD=-2.39,95%CI:-4.07~-0.71,P=0.005)and lower postoperative complications rate(OR=0.62,95%CI:0.49~0.80,P=0.0002),including lower wound infection(OR=0.55,95%CI:0.34~0.90,P=0.02)and incision hernia(OR=0.28,95%CI:0.13~0.61,P=0.001).There was no significant difference in blood loss,operative time,specimen length,number of lymph nodes obtained,duration of postoperative analgesia treatment,conversion to laparotomy,mortality,reintervention rate and other postoperative complications except wound infection and incisionhernia.Conclusions:TLC for right hemicolon carcinoma accelerates postoperative recovery with faster first flatus,shorter hospital stay,shorter incision length,and lower postoperative complications rate,including lower rate of wound infection and incision hernia.At the same time,TLC's shorter incision length matches the aesthetic pursuit of patient,while it fully embodies the advantages of minimally invasive.So we concluded that TLC has a better short-term effect in postoperative recovery while the same long-term effect.