Caudal to Cranial” Versus “Medial to Lateral” Approaches in Laparoscopic Right Hemicolectomy, Retrospective comparative study

Background: Laparoscopic right hemicolectomy (LRH) has emerged as the gold standard for the management of colorectal cancer involving the right colon. To optimize surgical outcomes, various techniques have been developed and implemented. Objective: To compare the efficacy of medial-to-lateral and caudal-to-cranial approaches in LRH.Methods: This retrospective study was conducted at General Surgery department, Ain Shams University Hospital on 60 patients who underwent LRH last 2 years between June 2021 to June 2023.Results: The mean surgical time of medial-lateral was about 134 minutes, while in caudal-cranial was about 143 minutes, which has no significant difference. The mean amount of blood loss during caudal-cranial technique was about 413 ml and about 414 ml with the medial-lateral technique, with no significant difference between them. The mean total harvested lymph nodes with caudal-cranial technique were about 22 lymph nodes, while medial-lateral technique was 17 lymph nodes with a significant preference for caudal to cranial technique. The mean number of positive lymph nodes was about 4 in both techniques. Postoperative hospital stay with both techniques showed no significant difference by the mean of 7 days. The mean wound healing time in both techniques was about 12 days.The mean percentage of postoperative leakage in caudal-cranial was about 3%, while it was about 6% in medial-lateral technique.The mean postoperative wound infection was 40% in caudal-cranial technique and about 33% with medial-lateral technique with no significant difference.Conclusion: Both medial-to-lateral and caudal-to-cranial approaches to LRH demonstrate comparable outcomes in terms of operative time, blood loss, postoperative hospital stay, and wound healing.Caudal-to-cranial technique exhibited a higher lymph node yield, although the clinical significance of this finding remains uncertain. Further research is imperative to elucidate the optimal surgical approach for LRH and its impact on long-term patient outcomes.