Comparative clinical efficacy of three surgical modalities for the treatment of malignant tumours of the left hemicolon.

BACKGROUND: The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial. We aimed to determine which procedures are best for patients with different characteristics. The focus of this study was to investigate the safety and clinical efficacy of three different surgical procedures, namely, robotic-assisted surgery (RAS), hand-assisted laparoscopic surgery (HALS) and conventional laparoscopic surgery (CLS), for the dissection of malignant tumors of the left hemicolon and the effect of these procedures on long-term prognosis. AIM: To determine which procedures are best for patients with malignant tumors of the left hemicolon and the safety and clinical efficacy of three different surgical procedures. METHODS: A retrospective analysis of the clinical data of 224 patients with left hemicolonic malignancies admitted to the Department of General Surgery of the First Affiliated Hospital of Nanchang University from June 2015 to June 2024 was conducted. Patient data were analyzed to determine tumor stage, duration of surgery, number of lymph nodes cleared, incidence and severity of postoperative complications, amount of intraoperative bleeding, overall survival (OS), and progression-free survival. RESULTS: The short-term postoperative outcomes after RAS, HALS and CLS were compared. The leukocyte and absolute neutrophil counts on postoperative day 4 were highest after RAS, followed by CLS and then HALS, and the differences were statistically significant (P < 0.05). The length of postoperative hospital stay was highest after CLS, followed by RAS and then HALS, and the differences were statistically significant (P < 0.05). The postoperative recovery time of gastrointestinal function was shortest after HALS, followed by RAS and CLS, which had equal values, and the differences were statistically significant (P < 0.05). Hospitalization costs were highest among patients who underwent RAS, followed by CLS and then HALS, and the differences were statistically significant (P < 0.05). The OS among patients who underwent HALS, CLS, and RAS did not significantly differ (P = 0.384). CONCLUSION: There were no significant differences between procedures in the number of lymph nodes cleared or OS, and all procedures successfully achieved radical dissection of the malignant tumors. HALS had lower hospitalization costs and shorter postoperative recovery time of gastrointestinal function, and CLS performed between HALS and RAS. Different surgical procedures have varying impacts on the length of postoperative hospital stay and the degree of postoperative inflammation, so selection should be individualized to each patient.