This paper raised several important points. First, making statements based on small numbers is risky. In this study, 9.1 % of the laparoscopic group had an anastomotic leak necessitating laparotomy and end-ileostomy; this is a high figure for a right hemicolectomy. Similarly, 4.5% of patients undergoing the laparoscopic approach died from massive blood loss. These results are almost certainly not significant (the absolute numbers were 2 and 1, respectively) but does demonstrate how misleading small studies can be.
If you adjusted for all variables, then laparoscopic surgery had no benefit over open surgery. It is only when it is combined with enhanced recovery do benefits in terms of length of stay become apparent.
This study cannot say that laparoscopic approach was any better than the open approach, only that laparoscopic with enhanced recovery was superior to open without enhanced recovery, which is correctly stated in the conclusion. This finding has been shown repeatedly before.1–3
This paper could just have easily been titled ‘Impact of enhanced recovery for right hemicolectomy for colon cancer’. We should await the results of the ENROL (Enhanced Recovery Open Laparoscopic Surgery for Colorectal Cancer) study before we advocate a complete laparoscopic colorectal operative approach.
References
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