“Caudal to Cranial” Versus “Medial to Lateral” Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolic Excision for the Treatment of Stage II and III Colon Cancer: Perioperative Outcomes and 5-Year Prognosis

Background: The purpose of this study was to compare the “caudal to cranial” (CC) versus “medial to lateral” (ML) approach for laparoscopic right hemicolectomy. Methods: Pertinent data from all patients with stage II and III between January 2015 and August 2017 were entered into a retrospective database. Results: A total of 175 patients underwent the ML (n = 109) or CC approach (n = 66). Patient characteristics were equivalent between groups. The CC group showed a shorter surgical time 170.00 (145.00, 210.00) vs. (206.50 (178.75, 226.25) min) than the ML group ( p＜0.001 ). The time to oral intake was shorter in the CC group than in the ML group ((3.00 (1.00, 4.00) vs. 3.00 (2.00, 5.00) days; p=0.007 ). For the total harvested lymph nodes, there was no statistical significance between the CC group 16.50 (14.00, 21.25) and the ML group 18.00 (15.00, 22.00) ( p = 0.327), and no difference was found in the positive harvested lymph nodes (0 (0, 2.00) vs. 0 (0, 1.50); p =0.753). Meanwhile, no differences were found in other perioperative or pathological outcomes, including blood loss and complications. For 5-year prognosis, overall survival rates were 75.76% in the CC group and 82.57% in the ML group (HR 0.654, 95% CI 0.336–1.273, p = 0.207); progress-free survival rates were 80.30% in the CC group and 85.32% in the ML group (HR 0.683, 95% CI 0.328–1.422, p = 0.305). Conclusions: Both approaches were safe and feasible and resulted in excellent survival. The CC approach was beneficial in terms of the surgical time and rapid recovery after operation.