Safe alternative approach of reduced three-port versus conventional five-port laparoscopic right hemicolectomy for right-sided colon cancer: a propensity score matching analysis.

Background: Laparoscopic surgery with reduced port for colorectal cancer is being increasingly implemented, but its feasibility and safety are still uncertain. This study aimed to evaluate the safety and effectiveness of three-port laparoscopic right hemicolectomy (3-LRHC) compared to the conventional five-port laparoscopic right hemicolectomy (5-LRHC) for right-sided colon cancer using propensity score matching analysis. Methods: A total of 311 patients diagnosed with right-sided colon adenocarcinoma underwent laparoscopic right hemicolectomy (LRHC) in two medical centers between January 2011 and May 2021. We analyzed the short-term outcomes, such as clinical characteristics, intraoperative and postoperative outcomes, postoperative pain score, pathologic results and the long-term outcomes such as overall survival, disease-free survival rate. Results: As a result of the propensity score matching method, 108 patients in each group were similarly selected by clinicopathological variables such as age, sex, American Society of Anesthesiologists (ASA) score, and stage. The mean operation time except open conversion, first day of oral diet, first day of drain removal was shorter in the 3-LRHC than in the 5-LRHC group. Thus, recovery of bowel function was found to be faster in 3-LHRC group than in 5-LRHC group. No significant differences were observed in postoperative complication and severity, postoperative pain scale, open conversion rate. The number of harvested lymph nodes, overall survival and disease-free survival rates between the two groups were also not significantly different. Conclusions: Reduced 3-LRHC has advantage of shortening the hospital stay due to rapid recovery of intestinal function and reduced pain without the need for additional instrument. There was no difference from 5-LRHC in terms of oncological outcomes and survival rates. Therefore, 3-LRHC for right-sided colon cancer may provide a safe and feasible alternative to conventional 5-LRHC.