While left colectomy for cancer is widely performed by miniinvasive surgery, there are, to date, numerous surgical centers that still practice right hemicolectomy totally by open approach or only partially by laparoscopy (with variations depending on whether colic mobilization and/or vascular ligation are made laparoscopically or not). Only few centers perform right colectomy totally by laparoscopy (vascular ligation, colon mobilization, colon specimen extraction by enlarged trocar incision or Pfannenstiel mini-incision, intracorporeal ileo-colic anastomosis). What do you think about?
Dear Dr Riccardo
it is a nice debate! as you know right colon cancer is diagnosed when tumor is huge and in advanced stage ( and some times invade adjacent organ like duedunm in comparison of left colon so right hemicolectomy in this situation is difficult by laparoscopy .so laparaccopy has limited role in right colon cancer and i myself prefer open surgery in advanced stage of right colon cancer.
I agree with Mahmoodzadeh. The evidence to compare surgical approaches still missing to define a gold standard for R colon surgery. Not only the large tumor but any size with lymphatic involvement definitely needs a total mesocolic excision. Total mesoocolic is somehow difficult by laparoscopy compared to open surgery. Robotic approach may be a new hope to overcome1
Hi, only if you are an expert you can go for a totally laparoscopic procedure. I agree with Dr. Mahmoodzade about the size of the lesion and tha size of the mesocolon but must importantly is that still nowadays the recurrence rate is still on debate, so if you perform this type of procedure in either way ir is ok with me and this is my teaching to my residents.
I do not expect a common idea that, even in the same department, there are surgeons prefer open approach especially for the lesions close to hepatic flexure that likely to need a more delicate dissection of mesocolic tissue. Probably a purely cecal tumor can be taken as a different entity compared to a proximal transverse colon tumor from the aspect of TMC resection
Do they spect from you the same, regarding your position?. Specially in training programs the fellows need to perform open procedures for learning as specialist. Remember that laparoscopy is another way to do it, not, as many think, that is the only way.
I think , it is important where tumor locates whether either somewhere cecum or close to hep. flexure in the ascending colon. We all know that long-tern outcomes of the randomized trial showed that about 14% of recurrence relevant surgical procedure done by laparoscopy for right colon cancer. It is very important that surgeons must give the great care on it. One of the message from the paper is that's experienced surgeons and dedicated cancer centers dealing with mnimal invasive surgery on this type of oncologic issue. The number of patients admitted to the center in a particular time period is vital as well. On the otherhand it is almost difficult making disection around the pancreatic head near to middle colic vessel and the area close to vascular supply (gastrocolic trunk and the henle arcade) using laparoscopic tools. there is lymphatic invasion in this particular area also. Dr. Gecim could be right about what he said on the Robotic colorectal surgical procedure. I have known about less than 3-4% recurrence in the series of patients with right colon cancer undergone minimal invasive surgery by using Robot (unpublished).
Far from being goldstandard, in my opinion, due to low implementation rate, especially in middle and low income countries.
The aim should be complete mesocolic excision.
If you can do it laparoscopically, and have all the skills, is perfect, and the way to go.
I do not think that exist any proved benefits for the robot compared to laparoscopy.
If for the rectum there are no level I evidente favoring robot, imagine right hemycolectomy.
I strongly agree with Dr. Negoi, thank you for your comment.
Thank you all, for the very interesting answers and considerations.
I think that, in a near future, also laparoscopic right colectomy will become the gold standard procedure for treating cancer, both for oncologic results and for mininvasivity more often requested from patients, expecially in western and economically advanced countries.
Obviously, randomized studies are needed to confirm my personal point of view.
Open access will be limited, in my opinion, to selected cases (operative risk, intraoperative complications or anatomical problems). Today, many skilled centers do that.
Regarding robotic surgery, I agree with dr. Negoi' s considerations.
Obviously, laparotomy represents the BASIC approach for all gastrointestinal operations and for all medical doctors who face with surgery.
Contratrary to open procedure, laparoscopic Rt. hemeicolectomy is more technically demanding than left sided surgery.But I feel it is oncologically safe
I am not sure why Rt Hemicolectomy is more technically demanding than left resections laparoscopcally,I routinely practice lap RHC Cranio caudal dissection.Easier no problem with me sentry and extracarporeal anastamosis is faster through the specimen extraction site.Recurrence rate is same if not less,