Objective To assess clinical outcomes of hand assisted laparoscopic right hemicolectomy (HALC) and standard laparoscopic right hemicolectomy (SLC). Methods The databases of Wanfang, CNKI, VIP, CBM, PubMed, Embase, and Cochrane Central Register of Controlled Trials were electronically searched. The relevant literatures were selected according to the inclusion and exclusion criteria. The Cochrane collaboration tool for assessing risk of bias was used to assess the quality of randomized controlled trials and the Newcastle-Ottawa Scale was used to assess non-randomized comparative studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 9 studies were included and involved 976 patients (480 patients in the HALC group and 496 patients in the SLC group). The results of meta-analysis showed that the HALC group was favor of shorter operative time as compared with the SLC group (P<0.05), but the length of incision and hospital stay were longer in the HALC group (P<0.05). There were no statistically significant differences between these two groups regarding as the conversion rate, time to return of bowel function, feeding time, reoperative rate during hospitalization, postoperative complications rate, and harvested lymph node number (P>0.05). As for the follow-up results, the 3-year survival rate was about 90%, and 5-year survival rate was about 80%, and there were no statistical differences in terms of recurrence rate and mortality between the HALC group and the SLC group (P>0.05). Conclusions Both HALC and SLC could achieve satisfactory minimal invasive outcomes and oncologic radical effects, and HALC has an advantage of shorter operative time, yet length of incision and hospital stay are longer than SLC. Therefore, HALC could be considered as an alternative to minimal invasive right hemicolectomy.
The technique of laparoscopic radical right hemicolectomy is becoming mature, but there are still controversies on some key steps, including the extent of lymph node dissection, the scope of bowel resection, the choice of surgical access and anastomosis. The new function-preserving surgery and natural-orifice transluminal endoscopic surgery (NOTES) have further enhanced the minimally invasive nature of surgery. The author’s have reviewed the latest domestic and international literature, combined with the experience of the author’s center, and elaborated on the current focus issues of laparoscopic radical surgery for right-sided colon cancer.