Comparison of laparoscopic versus open complete mesocolic excision in elderly patients with right hemicolon cancer: retrospective analysis of one single cancer

Objective: To investigate the clinical safety, performance, perioperative and oncologic outcome of laparoscopic complete mesocolic excision (CME) for elderly patients with right hemicolon cancer. Methods: A total of 82 patients with right hemicolon cancer who underwent CME between January 2011 and December 2012 were included in this study and divided into laparoscopic colectomy (LC, n=27) group and open colectomy (OC, n=55) group according to surgical procedure. Demographic variables, perioperative and oncologic outcomes of these two groups were compared. Results: There were no significant differences of demographic and tumor characteristics between two groups. During the surgical procedures, the patients in LC group had shorter incision length (P<0.05), longer operation time (P<0.05) and similar blood loss (P>0.05) compared to those in OC group. After the operation, compared to OC group, LC group had lower pain scores (P<0.05), proceeded an earlier first passage of flatus (P<0.05), and restored the ability to consume solid food sooner (P<0.05). Moreover, when LC group was compared to OC group, hospitalization (P<0.05) was recorded shorter, total costs (P<0.05) were increased, similar numbers of lymph nodes were obtained (P>0.05), and comparable levels of postoperative complications occurred (P>0.05). With a 39-month follow-up, significant differences of postoperative adjuvant chemotherapy, local recurrence, distant metastasis, 3-year overall survival and disease-free survival were not observed. Conclusions: Laparoscopic CME has short-term advantages and comparable long term outcomes compared to open CME. It is safer, more feasible and more effective minimally invasive surgery procedure for elderly patients with right hemicolon cancer.