Medial versus lateral approach for laparoscopic colectomy in colorectal cancer surgery

Background
Colorectal cancer is considered the third common malignancy worldwide, responsible for 9% of all cancer incidences. Currently, laparoscopy is widely practiced in colorectal cancer surgery. It is related to the surgeon’s experience to do either lateral-to-medial (L-M) or medial-to-lateral (M-L) approach. The two laparoscopic approaches are currently practiced, and there are conflicts of superiority of this over that and vice versa. We aimed to show if there is any superiority of one procedure over the other regarding short-term outcomes.
Patients and methods
This is a prospective randomized study of laparoscopic colorectal surgery. A total of 100 patients were included in this study. Patients were divided to two equal groups (M-L and L-M), with 50 patients each. The study was conducted from February 2017 to May 2021 in the General Surgery Department of Menoufia University Hospital. The study endpoints were the feasibility, technical efficacy, operative time, vascular or ureteric injury, and other complications of both techniques. We collected data according to patient demographics, technique of laparoscopic mobilization, surgery duration, hospital stay, operative and postoperative complications, and lymph node retrieval.
Results
A total of 100 patients with comparable demographic criteria had laparoscopic colorectal cancer surgery. Overall, 61 (61%) patients were males and 39 (39%) patients were females. A total of 50 (50%) patients underwent the M-L technique and the other 50 (50.0%) patients were operated upon using the L-M approach. Lateral approach had an average 10 ± 3 (4–22) lymph nodes with specimen compared with 17 ± 4 (9–31) in the medial approach. There was no statistically significant difference in the major complication rate (Clavien-Dindo IV) between the two approaches. The M-L approach showed significantly shorter operative time than the L-M approach in anterior resection and right hemicolectomy in favor of the M-L approach (<0.05). The L-M approach showed a significantly higher rate of conversion to open surgery (three in the L-M approach vs. one in the M-L) and injury to the ureter and gonadal vessels (<0.05). Patients in the M-L approach had a mean hospital stay of 5 ± 1 days (range, 3–52) compared with 5 ± 2 days (range, 3–56) in the L-M approach (not significant).
Conclusion
Both approaches were feasible for colon cancer surgery. The laparoscopic M-L approach was found to be technically easier and had less surgery-related complications than the L-M approach.