Christian Jurowich1, Sven Lichthardt2, Niels Matthes2, Caroline Kastner2, Imme Haubitz2, Andre Prock1, Jörg Filser1, Stefan Löb2,3, Christoph-Thomas Germer2,3, Armin Wiegering4,5,6. 1. Department of General, Visceral and Thoracic Surgery, Kreiskliniken Altötting / Burghausen, Vinzenz-von-Paul-Str. 10, 84503, Altötting, Germany. 2. Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany. 3. Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. 6, 97080, Würzburg, Germany. 4. Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany. wiegering_a@ukw.de. 5. Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. 6, 97080, Würzburg, Germany. wiegering_a@ukw.de. 6. Department of Biochemistry and Molecular Biology, University of Wuerzburg, Würzburg, Germany. wiegering_a@ukw.de.
Abstract
BACKGROUND: Access for right hemicolectomy can be gained by median or transverse incision laparotomy. It is not known whether these routes differ with regard to short-term postoperative outcomes. METHODS: Patients in the DGAV StuDoQ|ColonCancer registry who underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) were compared regarding Clavien-Dindo classification (CDC) complications (primary endpoint) as well as specific postoperative complications, operation time, length of stay, and MTL30 status (secondary endpoints). RESULTS: A total of 3700 StuDoQ registry patients underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) without additional interventions. The median and transverse access routes did not differ regarding CDC complication rates (CDC > =3a: 13.1% vs. 12.6%; p = 0.90). However, univariate and multivariate analyses showed that operation times (OR 0.71, 95% CI 0.62-0.81; p < 0.001), length of stay (OR 0.69, 95% CI 0.6-079; p < 0.001), and MTL30 (OR 0.7, 95% CI 0.61-0.81, p < 0.001) were significantly reduced in the transverse laparotomy group. CONCLUSIONS: For oncological right hemicolectomy, open transverse upper abdominal laparotomy appears to be superior to median laparotomy in short-term course.
BACKGROUND: Access for right hemicolectomy can be gained by median or transverse incision laparotomy. It is not known whether these routes differ with regard to short-term postoperative outcomes. METHODS:Patients in the DGAV StuDoQ|ColonCancer registry who underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) were compared regarding Clavien-Dindo classification (CDC) complications (primary endpoint) as well as specific postoperative complications, operation time, length of stay, and MTL30 status (secondary endpoints). RESULTS: A total of 3700 StuDoQ registry patients underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) without additional interventions. The median and transverse access routes did not differ regarding CDC complication rates (CDC &gt; =3a: 13.1% vs. 12.6%; p = 0.90). However, univariate and multivariate analyses showed that operation times (OR 0.71, 95% CI 0.62-0.81; p &lt; 0.001), length of stay (OR 0.69, 95% CI 0.6-079; p &lt; 0.001), and MTL30 (OR 0.7, 95% CI 0.61-0.81, p &lt; 0.001) were significantly reduced in the transverse laparotomy group. CONCLUSIONS: For oncological right hemicolectomy, open transverse upper abdominal laparotomy appears to be superior to median laparotomy in short-term course.
Entities:
Keywords:
Abdominal laparotomy; Colon cancer; Complete mesocolic excision; Midline incision; Right side hemicolectomie; Tranverse incision
Authors: Claudio F Feo; Panagiotis Paliogiannis; Alessandro Fancellu; Angelo Zinellu; Giorgio C Ginesu; Carlo V Feo; Alberto Porcu Journal: Medicina (Kaunas) Date: 2021-01-19 Impact factor: 2.430