LAPAROSCOPIC VERSUS OPEN RIGHT CME COLECTOMY FOR RIGHT COLON CANCER: PRELIMINARY RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Aim: The aim of this randomized controlled trial is to compare laparoscopic and open CME right colectomy for right colon cancer, in terms of perioperative results, specimen characteristics and long-term oncological results. We report the preliminary results of our protocol.

Method: This RCT (NCT05713903) is conducted in the University Hospital of Larissa. The inclusion criteria are the following: histologically confirmed right colon cancer, CME resection, age<90 years, ASA ≤III, T ≤3, elective operations and signed informed consent. After inclusion, patients are randomized in either laparoscopic or open technique for CME right colectomy. A medial-to-lateral and lateral-to-medial approach is respectively utilized. The primary outcome is the rate of the mesocolic resection plane. Secondary outcomes include perioperative factors, morbidity, and specimen quality characteristics.

Results: Overall, 77 patients (females: 36, males: 41) have been included in our study so far. Mean age was 70.17(10.12) in the lap group and 78.028(11.15) in the open group. Patients in both arms were comparable in terms of ASA score (p=0.139), BMI (p=0.874) and major comorbidities such as atrial fibrillation, diabetes and arterial hypertension(p=0.377). In 32 patients the tumor was located in the caecum, in 33 in ascending colon, in 9 in hepatic flexure and in 3 patients it was in the appendix. The two techniques were equivalent in the preservation of the mesocolic resection plane (p=0.926). Laparoscopic colectomy was associated with longer operation duration (175.128 vs 125.294 min, p<0.001) and smaller incision length (5.512 vs 21.778 cm, p<0.001) whereas hospitalization and overall and septic postoperative complications were comparable. The two arms did not differ in the various specimen characteristics.

Conclusion: Preliminary results of this RCT suggest equivalence of the two approaches in the mesocolic resection rate, specimen quality indicators and postoperative morbidity. An improvement in cosmesis comes at the cost of a longer operation duration.