Comparative analysis of primary retroperitoneal and transabdominal approach in laparoscopic left colon cancer surgery: a case-match study

Introduction. Primary retroperitoneal and transabdominal approaches are recently described for D3 lymph node dissection for left colon cancer. Both approaches can be technically managed using a system of surgical planes and anatomical landmarks.Materials and Methods. The study included 28 patients who underwent minimally invasive surgery for adenocarcinoma of the left colon using navigation within virtual surgical planes. Patients were managed by age, sex, body mass index (BMI), ASA, and level of inferior mesenteric artery ligation. As a result, 14 pairs of patients were compared regarding the short-term results of surgery using conventional transabdominal and primary retroperitoneal approaches.Results. The length of surgery (250 min vs. 305 min, p=0.277), blood loss, harvested apical (3 vs. 2 lymph nodes, p=0.376) lymph nodes were comparable. Time to first flatus (1,5 day vs. 1 day, p=0.874) and first defecation (3,5 days vs. 3 days, p=0.804), hospital stay (8,5 days vs. 8 days, p=0.874), and incidence of postoperative complications (p=0.308) were not different.Conclusion. Primary retroperitoneal approach can be used as an alternative to transabdominal access in left colorectal cancer surgery. Comparable short-term results of surgical treatment with both approaches may be reached with the use of navigation within surgical planes and anatomical landmarks.