Emergency right colectomy: is there a role for minimally invasive surgery?-A systematic review and meta-analysis of short-term clinical outcomes

Background: In well selected emergency settings, laparoscopic-assisted (LA) right colectomy can be safely performed with similar results to elective right colectomy in terms of intra-operative blood loss, postoperative complications and length of recovery. However, evidence is still lacking in regards to whether laparoscopy can safely replace traditional open surgery (OS) for patients needing emergency right colectomy. This systematic review and meta-analysis is aiming to present an updated evaluation of the short-term clinical outcomes of laparoscopic and open approaches for right colectomy performed in emergency settings, by analyzing safety and feasibility of the two techniques. Methods: Systematic literature search was performed using MEDLINE (via PubMed), Cochrane, Scopus, Web of Science and EMBASE databases. All the included studies compared LA and OS right colectomy for right colon emergencies including obstructing or bleeding colon cancer and complicated cecal diverticulitis. Results: Three retrospective cohort studies comparing LA and OS were included for qualitative and quantitative synthesis. LA and OS showed equivalent results in terms of mean estimated intra-operative blood loss, mean number of retrieved lymph nodes, and rate of R0 resections. Meta-analyses of postoperative outcomes showed similar results between the LA and OS groups in terms of surgical site infection, time to bowel movements and length of hospital stay. LA showed statistically significant lower rates of postoperative complications and shorter mean time out from bed after surgery compared to OS. Conclusions: Although limited by the risk of imprecision due to the small sample size and the low level of evidence of the reported outcomes, this systematic review and meta-analysis demonstrated that LA right colectomy has the same safety profiles compared to the traditional open technique. Possible advantages of laparoscopy in right colectomy are related to lower rates of postoperative complications and shorter mean time out from bed after surgery.