the advantages of laparoscopic colectomy , which include reduced requirements for analgesics , a lower incidence of wound infection , earlier resumption of a regular diet , faster return of bowel function and normal daily activities , and a shorter hospital stay , have been well documented . however , whether these advantages can be weighed against the potential disadvantages of a longer operating duration , probably reduced tumor clearance rate due to limited operating view or loss of tactile sensation during the procedure , increased equipment costs , and most importantly the potential increased morbidity or mortality associated with conversion have not been adequately assessed . the majority of studies on laparoscopic colectomy include a heterogeneous group of patients who underwent different operative procedures and compared patients with benign and malignant disease in a single study . the aim of this study was to review the outcomes of patients who received laparoscopic right hemicolectomy for carcinoma of cecum , ascending colon , and hepatic flexure and to compare the results with those of open surgery . it was postulated that morbidity and mortality were comparable between patients who underwent laparoscopic and open right colectomy for malignancy . from june 2000 to december 2004 , 182 patients underwent right colectomy for cancer of the right colon ( from cecum to hepatic flexure ) in the department of surgery , university of hong kong medical centre , queen mary hospital . seventy - seven patients had laparoscopic resection ( lr ) while the other 105 were operated on with open resection ( or ) . only patients were included who had confirmed carcinoma of the cecum , ascending colon , or hepatic flexure and who underwent an elective operation of either open or laparoscopic right or extended right hemicolectomy . patients who had benign disease and who were operated on in an emergency setting were excluded . the surgeons and the patients decided on the choice of the approach after thorough discussion of the procedures and the possible morbidity . the principle cancer surgeries , which include en bloc resection , adequate lymphadenectomy with ligation of lymphovascular pedicles , and clear resection margins , were followed up for both open and laparoscopic resections . the patients received mechanical bowel preparation with polyethylene glycol electrolyte solution the day before the operation , and intravenous antibiotics were administered at the time of anesthesia . in the case of laparoscopic resection , the peritoneal cavity was accessed with the open hasson technique through a subumbilical incision , and a 12-mm trocar was inserted under direct vision . pneumoperitoneum was established and maintained with carbon dioxide at a pressure of about 12 mm hg . a small incision at the right upper quadrant or at the midline was made , and the mobilized colon was retrieved out of the peritoneal cavity under wound protection . demographic data including sex , age , and the american society of anesthesiology class ; intraoperative parameters including blood loss and duration of surgery ; postoperative outcome measures , such as the time to resumption of a normal diet and bowel function , duration of hospital stay , overall morbidity and mortality rate ; and follow - up data were collected prospectively . comparisons between the 2 groups were performed on an intention - to - treat basis . continuous variables were analyzed with the student t test or mann - whitney u test . survival was analyzed by the kaplan meier method , and the groups were compared by log - rank test . from june 2000 to december 2004 , 182 patients underwent right colectomy for cancer of the right colon ( from cecum to hepatic flexure ) in the department of surgery , university of hong kong medical centre , queen mary hospital . seventy - seven patients had laparoscopic resection ( lr ) while the other 105 were operated on with open resection ( or ) . only patients were included who had confirmed carcinoma of the cecum , ascending colon , or hepatic flexure and who underwent an elective operation of either open or laparoscopic right or extended right hemicolectomy . patients who had benign disease and who were operated on in an emergency setting were excluded . the surgeons and the patients decided on the choice of the approach after thorough discussion of the procedures and the possible morbidity . the principle cancer surgeries , which include en bloc resection , adequate lymphadenectomy with ligation of lymphovascular pedicles , and clear resection margins , were followed up for both open and laparoscopic resections . the patients received mechanical bowel preparation with polyethylene glycol electrolyte solution the day before the operation , and intravenous antibiotics were administered at the time of anesthesia . in the case of laparoscopic resection , the peritoneal cavity was accessed with the open hasson technique through a subumbilical incision , and a 12-mm trocar was inserted under direct vision . pneumoperitoneum was established and maintained with carbon dioxide at a pressure of about 12 mm hg . a small incision at the right upper quadrant or at the midline was made , and the mobilized colon was retrieved out of the peritoneal cavity under wound protection . demographic data including sex , age , and the american society of anesthesiology class ; intraoperative parameters including blood loss and duration of surgery ; postoperative outcome measures , such as the time to resumption of a normal diet and bowel function , duration of hospital stay , overall morbidity and mortality rate ; and follow - up data were collected prospectively . comparisons between the 2 groups were performed on an intention - to - treat basis . continuous variables were analyzed with the student t test or mann - whitney u test . survival was analyzed by the kaplan meier method , and the groups were compared by log - rank test . spss software version 11.0 ( spss corp . , chicago , il , usa ) was used for the analysis . preoperative comorbidities according to american society of anesthesiology class and the stage of the diseases were also similar . demographics for laparoscopic resection and open resection groups lr = laparoscopic right hemicolectomy ; or = open right hemicolectomy ; asa = american society of anesthesiology ; uicc : union internationale contre le cancer . among the 77 patients in the lr group , 7 ( 9% ) patients were converted to an open procedure . two conversions were due to dense adhesions from previous open cholecystectomy . the other 5 patients were converted because of advanced tumors that invaded the adjacent organs including duodenum , retroperitoneum , and abdominal wall . there was no difference in mean blood loss between patients who underwent lr and or ( 178ml vs 158 ml , respectively , p=0.918 ) . the mean operating time for lr was significantly longer than that for or ( 165 minutes vs 115 minutes , respectively p<0.001 ) . regarding the postoperative recovery , the median time to resumption of a normal diet was 3 days ( range , 0 to 10 ) in lr patients , while or patients required a median of 4 days ( range , 0 to 25 ) ( p0.001 ) . the median hospital stay for lr patients was 6.0 days ( range , 3 to 72 ) compared with 7.0 days ( range , 4 to 102 ) in or patients ( p0.001 ) . when the 7 converted - to - open ( lcor ) patients were analyzed as a subgroup , it was found that those who had successful laparoscopic surgery ( n=70 ) had a median hospital stay of 5.5 days ( range , 3 to 72 ) , which compared favorably with the or ( 7.0 days , p0.001 ) and lcor ( 9.0 days , p0.001 ) groups . there was no statistically significant difference in overall nonsurgically or surgically related complications , as listed in table 2 . two ( 28.5% ) of the lcor patients had prolonged ileus of more than 5 days compared with 2 ( 1.9% ) in the or patients , p<0.01 , whereas other complications as well as the overall complication rate did not show any statistical difference ( table 3 ) . surgery related complications of open vs laparoscopic right hemicolectomy converted to open hemicolectomy no 30-day mortality occurred in the lr group , but 3 or patients died after the operation . the mean number of lymph nodes sampled in lr and or patients was 15.81.4 and 16.71.58 , respectively ( p=0.699 ) . the mean length of the specimen in lr and or groups was 26.813.5 and 26.41.7 , respectively , ( p=0.742 ) . the median durations of follow - up in lr and or group patients were 22.3 months and 20.8 months , respectively , p=0.578 . there were 2 loco - regional recurrences in the lr and 5 in the or group and 9 systemic recurrences in each group of patients . the 2-year survival rates were 74.23% and 74.17% in the lr and or groups , respectively ( figure 1 ) . therefore , no differences in loco - regional recurrence , systemic recurrence , or survival rate occurred in both groups of patients . overall survival of patients with open and laparoscopic right colectomy ( p=0.9045 ) . the median durations of follow - up in lr and or group patients were 22.3 months and 20.8 months , respectively , p=0.578 . there were 2 loco - regional recurrences in the lr and 5 in the or group and 9 systemic recurrences in each group of patients . the 2-year survival rates were 74.23% and 74.17% in the lr and or groups , respectively ( figure 1 ) . therefore , no differences in loco - regional recurrence , systemic recurrence , or survival rate occurred in both groups of patients since the first report of successful laparoscopic colectomy by jacob et al in 1991 , there has been rapid development of laparoscopic colonic surgery in the past decade . the majority of colorectal procedures can now be performed with the laparoscopic approach . laparoscopic colonic resection has become the preferred treatment option for diverticular disease . however , the concern about port - site recurrence , the radicality of resection , and the oncologic outcome limited the application of laparoscopic colectomy for malignant disease . when compared with left - sided colon resection , laparoscopic right colectomy thus , laparoscopic right colectomy has a slower pace of development compared with surgery for left - sided colon . there are controversies about whether laparoscopic colectomy has advantages over the open procedure applied in right - sided colonic lesions . few publications specifically compare the outcomes in patients who underwent laparoscopic right hemicolectomy for colon cancer with those who were treated with the open approach . among these , preliminary results of comparable morbidity , mortality , oncologic clearance , and survival rate were demonstrated . however , the number of subjects included in these studies was relatively small , and they were included over a long period of time . the current study included a sizable number of patients with cancer of the right colon , and medium - term oncologic results were also evaluated . admittedly , this is not a randomized controlled trial and selection bias could not be avoided . however , the demographics of the patients and the stages of the tumors were comparable in the 2 groups . the 2 groups of patients were operated on within the same period with similar preoperative and postoperative management . the mean operating time was invariably longer in the lr group , 165 minutes due to the more complicated surgical technique requirements as shown in other trials . the learning curve has been quoted to range from 11 to 50 cases or longer compared with the learning curve for open and rectal cancer surgery . no difference in blood loss between the 2 groups of patients was demonstrated in our trial . the median time to resumption of a normal diet is one day earlier in lr than in or patients . despite this , when taking into account that these 2 factors were important considerations in discharging patients from the hospital , they can be regarded as the reasons for the shorter hospital stay in the lr group . another important finding in breaking down the lr group into those with success ( lrs ) and those needing conversion ( lcor ) is that lrs had a 5.5-day hospital stay , which is ere significantly shorter than the 9 days for the lcor group . this also brought out a further issue that if the procedure was converted , the hospital stay was even longer than that in the or group . the main reasons were advanced disease with invasion to adjacent organs and the presence of adhesions from previous operations . conversion in our series is associated with poor outcomes with an increased complication rate and hospital stay . in analyzing the morbidity rate no difference could be demonstrated in nonsurgically related complications , such as cardiovascular accidents , chest infection , urinary tract infection , deep vein thrombosis , and surgical - related complications like wound infection , anastomotic leakage , ileus , intraabdominal collections . despite the fact that the overall complication rate is not statistically significant ( p=0.085 ) , 42.8% in the lcor group had complications compared with only 8.5% in the or group . therefore , careful selection of patients to minimize the conversion rate so as to minimize the morbidity rate is recommended . in this retrospective study , unfortunately , selection bias was another limitation . patients were selected for the laparoscopic approach if no absolute contraindication existed instead of being randomized into either group . a randomized controlled trial is thus warranted to further investigate the selection criteria for who is suitable for lr and who is not . as with many other published data , we did not find any difference in the oncologic clearance , loco - regional recurrence rate , systemic recurrence rate , and 2-year survival rate . morbidity , mortality , and short - term survival were comparable in the lr and or groups with the advantages of earlier resumption of a normal diet and a shorter hospital stay and the disadvantage of longer operating time and risk of conversion with possibly associated increased morbidity . laparoscopic right hemicolectomy has comparable morbidity and mortality rates as those of the conventional open procedure . it is superior to the conventional open approach in terms of shorter hospital stay and earlier resumption of a normal diet . however , conversion to open is associated with a longer hospital stay and possibly higher morbidity .
objective : this study aimed to compare the outcomes of laparoscopic resection ( lr ) with open resection ( or ) for right - sided colon cancer.methods:during the study period from june 2000 to december 2004 , 182 patients ( 84 men ) underwent elective resection for cancer of the right colon . 
 laparoscopic resection was performed in 77 patients , while 105 patients had open operations . 
 patients who underwent operations on an emergency basis were excluded . 
 data on the patients ' demographics , operative details , and postoperative complications were collected prospectively . 
 the outcomes of patients with laparoscopic resection were compared with those of patients with open surgery.results:there was no difference in the age , sex , presence of premorbid medical conditions , and blood loss between the 2 groups . 
 the mean operative time for open resection was 115.4 minutes and that for laparoscopic resection was 165.1 minutes ( p<0.001 ) . among the 77 patients who underwent laparoscopic resection , 7 ( 9% ) required conversion to an open operation . 
 there was no difference in postoperative surgically related complications including wound infection , leakage , intestinal obstruction , postoperative ileus . 
 nonsurgical - related complications were also similar . 
 the median time to resumption of a normal diet was 3 days and 4 days in the laparoscopic and open groups , respectively . 
 the median hospital stay in patients with laparoscopic resection was significantly shorter than in patients with open surgery ( 6.0 days vs 7.0 days , p<0.001 ) . 
 the 2-year overall survival rates were 74% in both groups ( p=0.904 ) . in the converted to open ( lcor ) group , the hospital stay was significantly longer ( lr vs or vs lcor , 5.5 days vs 7.0 days vs 9.0 days respectively , p<0.001).conclusion : laparoscopic right hemicolectomy is a safe option for cancers of the right colon . 
 it is associated with a shorter hospital stay and earlier resumption of a normal diet . 
 mortality and morbidity are similar to that with the open approach . 
 there is no compromise in the survival of patients .