Access matters: suprapubic-centered surgery as alternative to the transumbilical approach in laparoscopic right colectomy for colon cancer - a propensity score matched analysis.

INTRODUCTION: The Pfannenstiel incision has replaced the umbilicus as retrieval site in minimally invasive right colectomy. The aim of this study was to evaluate whether shifting the entire procedure towards a suprapubically centered access site provides additional advantages in terms of procedural safety, oncologic outcomes, recovery times and complication rates. METHODS: A matched pair analysis was performed that compared 27 patients undergoing suprapubic laparoscopic right colectomy (study group) and 27 patients treated by transumbilical laparoscopic right colectomy (control group). Patients were matched based on age, gender and BMI. Total lymph node yield, conversion and complication rates, procedural duration, and length of stay were defined as primary outcome parameters. RESULTS: Patients with a suprapubically centered surgery showed similar postoperative complication and conversion rates as compared to control patients. Suprapubic laparoscopic right colectomy was associated with the need for a higher number of additional working trocars (P < 0.05), showed a trend towards an increased total lymph node yield (P = 0.056), and significantly reduced the risk for postoperative incisional hernia development to 0% (P < 0.05). CONCLUSION: Suprapubic laparoscopic right colectomy for malignant colon cancer is safe and feasible, providing similar postoperative complication rates. This technique is favored due to a higher total lymph node harvest and a significant reduction of incisional hernia risk as compared to transumbilical laparoscopic right colectomy.