After obtaining approval from the institutional ethics committee, we carried out a retrospective analysis of patients with right-sided colonic adenocarcinoma who underwent LRH or ORHT between March 2004 and September 2006 at the Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand. Only American Society of Anesthesiologists (ASA) class I and II patients undergoing elective curative procedures were included. Curative procedures were defined as those in which there was no pre- or intra- operative evidence of distant metastasis and there was no postoperative macroscopic residual tumor.
Patients who were immunocompromised, receiving antiplatelet or anticoagulant drugs, or who had a history of previous intra-abdominal operations, recurrent tumors, adjacent organ resection, or acute complicated conditions such as colonic obstruction or perforation, perioperative epidural analgesia or failed laparoscopic procedure that needed conversion to open surgery were excluded.
Patients were interviewed to establish their medical history and a thorough physical examination was performed. Preoperative investigation included barium enema, complete colonoscopy with biopsy, chest X-ray, ultrasonography or CT scan of upper abdomen, and relevant serum tests.
All operations were performed by one of the authors. Type of the operation was depended on the surgeon's preference. A signed informed consent was provided by every patient. Each patient underwent preoperative mechanical bowel preparation using 2 liters of polyethylene glycol a day before surgery. All patients received general anesthesia. Intravenous prophylaxis antibiotics were also administrated.
In the cases receiving LRH, a vertical midline 1.5 cm incision was made just above the umbilicus for zero-degree camera port, and another three 0.5 cm incisions were made for instrumental trocars. The camera port was extended upward for extracorporeal ileocolonic anastomosis at the end of the operation. In the cases receiving ORHT, an incision was made along the skin crease on the right side of abdomen, about 1 cm above the umbilicus.
A standard oncological right hemicolectomy with high vessel ligation, wide excision and stapled side-to-side ileocolonic anastomosis was performed on all patients in both groups. The incision was closed in layers. No intra-abdominal drain or nasogastric tube was used. Prophylactic intravenous antibiotics were discontinued within 24 hours.
Routine postoperative care was provided for each patient. The time elapsing before first bowel movement (passing flatus) was recorded by nursing staff. Patients were allowed oral fluids if passing flatus. Resumption of normal diet was decided by agreement between surgeons and patients. Patients were discharged from the hospital when they displayed no fever, good appetite and satisfactory mobility. All patients were scheduled for postoperative follow-up 30 days later.
The data recorded included patients' demographic and operative details (length of incision, operating time, blood loss and postoperative complications), recovery details (time to first bowel movement, time to defecation, time to resumption of normal diet, time to discontinuation of intravenous narcotics and length of hospital stay) and oncological details (tumor size, lymph node harvest, resection margin).
Data were complied using a SPSS computer program (version 10.0 for Windows) and the Kolmogorov-Samirnov test was used to evaluate the data distribution. An unpaired t-test was used to compare data between the two groups of patients when these were found to be in normal distribution pattern. The Mann-Whitney U test was used when this was not the case. A p-value of less than 0.05 was considered statistically significant.