Inferior versus medial approach in laparoscopic and robotic colectomy for right-sided colon cancer: propensity score-matched analysis

Background Right-sided colon cancer surgery is a highly difficult operation, and ensuring perioperative safety is an important issue. While various approaches have been proposed for right-sided colon cancer, there are few reports comparing them. The present study compared the inferior approach (IA) and medial approach (MA) for right-sided colon cancer surgery and evaluated their safety. Methods We compared 528 cases of right-sided colon cancer surgery performed at our five affiliated institutions from 2017 to 2023, divided into IA and MA groups of 122 cases each using propensity score matching. Short-term outcomes of both groups were retrospectively evaluated, focusing on perioperative complications and perioperative mortality as the primary outcomes. Results After propensity score matching, all baseline variables were well balanced. No statistically significant difference (p < 0.05) was observed between the two groups in the incidence of postoperative complications, and no cases of severe complications were observed in either group. The incidence rates of CD ≥ 3 complications (IA/ MA): anastomotic leakage (0%/ 0.8%); intra-abdominal abscess (0.8%/ 1.6%); surgical site infection (0.8%/ 3.2%); ileus (0%/ 0.8%); and anastomotic bleeding: (0%/ 0%). Postoperative hospital stay was significantly shorter in the IA group. Although there was a significant difference in the number of dissected lymph nodes, both groups had good R0 resection rates. Conclusions Both IA and MA represent safe and feasible approaches for right-sided colon cancer and can be selected based on the surgeon’s preference.