2D vs 3D laparoscopic right colectomy: A propensity score-matching comparison of personal experience with systematic review and meta-analysis

Table 1 Demographics characteristics of personal series

	Before propensity score matching			After propensity score matching
	2D, n = 111	3D, n = 52	P value	2D, n = 47	3D, n = 47	P value
Age (yr), mean ± SD	68.6 ± 12.9	73.2 ± 12.5	0.006	71.8 ± 12.3	72.8 ± 12.4	0.538
Sex, n (%)			0.252			1.000
M	64 (57.7)	25 (48.1)		25 (53.2)	25 (53.2)
F	47 (42.3)	27 (51.9)		22 (46.8)	22 (46.8)
BMI, mean ± SD	25.0 ± 3.1	24.7 ± 2.9	0.498	24.4 ± 2.2	24.9 ± 3.0	0.661
ASA, n (%)			0.645			0.997
1	21 (18.9)	9 (17.3)		7 (14.9)	7 (14.9)
2	58 (52.3)	23 (44.2)		23 (48.9)	22 (46.8)
3	31 (27.9)	19 (36.5)		16 (34.0)	17 (36.2)
4	1 (0.9)	1 (1.9)		1 (2.1)	1 (2.1)
CACI (median, range)	4 (0-16)	5 (0-12)	-	5 (0-9)	5 (0-12)	-
CACI, mean ± SD	4.00 ± 3.22	4.78 ± 3.17	0.165	4.27 ± 2.78	4.66 ± 2.92	0.635
Tumor size (cm), mean ± SD	4.31 ± 1.44	4.21 ± 1.90	0.426	4.42 ± 1.43	4.13 ± 1.87	0.223

BMI: Body mass index; ASA: American Society of Anesthesiology; CACI: Charlson Age-Comorbidities Index.

Table 2 Operation details and postoperative course of personal series

	Before propensity score matching			After propensity score matching
	2D, n = 111	3D, n = 52	P value	2D, n = 47	3D, n = 47	P value
Type of right colectomy, n (%)			0.013			0.836
CME	41 (36.9)	30 (57.7)		24 (51.1)	25 (53.2)
No CME	70 (63.1)	22 (42.3)		23 (48.9)	22 (46.8)
Operative time (min), mean ± SD	185.3 ± 48.6	169.8 ± 32.4	0.087	183.8 ± 35.4	170.7 ± 32.9	0.053
Anastomotic time (min), mean ± SD	19.3 ± 2.9	16.9 ± 2.3	< 0.001	19.6 ± 2.9	16.9 ± 2.3	< 0.001
Associated procedures, n (%)	40 (36.0)	25 (48.1)	0.143	20 (42.6)	22 (46.8)	0.678
Complexity of associated procedures, mean ± SD	4.06 ± 0.89	3.92 ± 0.79	0.615	3.82 ± 0.82	3.91 ± 0.82	0.682
Conversion, n (%)	10 (9.0)	1 (1.9 )	0.178	1 (2.1)	1 (2.1)	1.000
Time to first flatus (d), mean ± SD	3.21 ± 1.26	3.25 ± 1.08	0.606	3.46 ± 0.99	3.31 ± 1.10	0.375
Hospital Stay (d, median)	7 (3-60)	7 (4-15)	-	7 (3-24)	7 (4-15)	-
Hospital Stay (d), mean ± SD	8.36 ± 5.89	7.69 ± 2.17	0.858	8.08 ± 3.43	7.80 ± 2.24	0.877
Postoperative complications, n (%)			0.937			0.626
Yes	25 (22.5)	12 (23.1)		10 (21.3)	12 (25.5)
No	86 (77.5)	40 (76.9)		37 (78.7)	35 (74.5)
Clavien-Dindo Classification, n (%)			0.729			0.781
I-II	20 (80.0)	9 (75.0)		8 (80.0)	9 (75.0)
III-IV	5 (20.0)	3 (25.0)		2 (20.0)	3 (25.0)
Type of complication, n (%)
Anastomotic bleeding	0 (0.0)	1 (1.9)		0 (0.0)	0 (0.0)
Anastomotic leak	1 (0.9)	0 (0.0)		1 (2.1)	0 (0.0)
Intra-abdominal bleeding	0 (0.0)	1 (1.9)		0 (0.0)	0 (0.0)
Canalization delay	12 (10.8)	4 (7.7)		5 (10.6)	4 (8.4)
Neurological	0 (0.0)	1 (1.9)		0 (0.0)	1 (2.1)
Cardiac	2 (1.8)	2 (3.8)		1 (2.1)	1 (2.1)
Pulmonary	4 (3.6)	2 (3.8)		2 (4.2)	2 (4.2)
Urinary	1 (0.9)	0 (0.0)		0 (0.0)	0 (0.0)
Wound infection	1 (0.9)	1 (1.9)		1 (2.1)	1 (2.1)
Other	3 (2.7)	5 (9.6)		1 (2.1)	5 (10.6)
30 d mortality, n (%)	2 (1.8)	1 (1.9)	1.000	1 (2.1)	1 (2.1)	1.000

CME: Complete mesocolic excision.

Table 3 Oncological outcomes of personal series

	Before propensity score matching			After propensity score matching
	2D, n = 111	3D, n = 52	P value	2D, n = 47	3D, n = 47	P value
T-stage, n (%)			0.340			0.921
Adenoma	7 (6.3)	8 (15.4)		6 (12.8)	8 (17.0)
pTis	5 (4.5)	1 (1.9)		3 (6.4)	1 (2.1)
pT1	14 (12.6)	8 (15.4)		8 (17.0)	7 (14.9)
pT2	24 (21.6)	7 (13.5)		8 (17.0)	7 (14.9)
pT3	49 (44.1)	25 (48.1)		18 (38.3)	21 (44.7)
pT4a	7 (6.3)	1 (1.9)		2 (4.3)	1 (2.1)
pT4b	5 (4.5)	2 (3.8)		2 (4.3)	2 (4.3)
N-stage, n (%)			0.518			0.899
pN0	81 (73.0)	42 (80.8)		36 (76.6)	37 (78.7)
pN1	22 (19.8)	8 (15.4)		8 (17.0)	8 (17.0)
pN2	8 (7.2)	2 (3.8)		3 (6.4)	2 (4.3)
Retrieved nodes, mean ± SD	19.6 ± 6.6	18.8 ± 7.4	0.400	17.8 ± 5.2	18.9 ± 7.3	0.654
Positive nodes, mean ± SD	2.80 ± 1.91	2.30 ± 2.00	0.232	2.63 ± 1.80	2.30 ± 2.00	0.478
Node ratio, mean ± SD	0.15 ± 0.13	0.14 ± 0.16	0.346	0.15 ± 0.15	0.14 ± 0.17	0.574

Table 4 Main features of complete mesocolic excision patients

	Before propensity score matching			After propensity score matching
	2D, n = 41	3D, n = 30	P value	2D, n = 24	3D, n = 5	P value
Age (yr), mean ± SD	70.1 ± 12.6	74.7 ± 11.4	0.037	70.8 ± 13.1	74.2 ± 11.2	0.352
Sex, n (%)			0.258			0.199
M	26 (63.4)	15 (50.0)		10 (41.7)	15 (60.0)
F	15 (36.6)	15 (50.0)		14 (58.3)	10 (40.0)
BMI, mean ± SD	24.6 ± 3.0	24.4 ± 2.8	0.620	23.9 ± 2.0	24.7 ± 2.9	0.610
CACI, median (range)	4 (0-16)	5 (0-12)	-	4.5 (0-9)	4 (0-12)	-
CACI, mean ± SD	3.95 ± 2.78	5.23 ± 3.34	0.250	4.04 ± 2.89	5.08 ± 2.94	0.420
Tumor size (cm), mean ± SD	4.26 ± 1.71	4.52 ± 1.88	0.478	4.33 ± 1.52	4.42 ± 1.77	0.840
Operative time (min), mean ± SD	208.0 ± 40.0	172.6 ± 37.1	< 0.001	193.7 ± 37.1	175.0 ± 38.5	0.063
Anastomotic time (min), mean ± SD	20.2 ± 2.6	16.6 ± 1.8	< 0.001	19.9 ± 3.0	16.5 ± 1.8	< 0.001
Associated procedures, n (%)	17 (41.5)	17 (56.7)	0.205	10 (41.7)	14 (56.0)	0.316
Complexity of associated procedures, mean ± SD	3.80 ± 0.69	4.08 ± 0.85	0.420	3.75 ± 0.84	4.10 ± 0.92	0.355
Time to first flatus (d), mean ± SD	3.53 ± 1.58	3.23 ± 1.04	0.492	3.45 ± 1.06	3.36 ± 1.07	0.681
Hospital stay (d, median)	7 (3-60)	7 (6-15)	-	7 (3-24)	7 (6-15)	-
Hospital Stay (d), mean ± SD	8.90 ± 8.89	8.13 ± 2.44	0.231	8.16 ± 4.29	8.44 ± 2.55	0.333
Postoperative complications, n (%)			0.646			0.376
Yes	9 (26.7)	8 (22.0)		5 (20.8)	8 (32.0)
No	32 (77.5)	22 (76.9)		19 (79.2)	17 (68.0)
Clavien-Dindo Classification, n (%)			0.893			0.835
I-II	7 (80.0)	6 (75.0)		4 (80.0)	6 (75.0)
III-IV	2 (25.0)	2 (22.2)		1 (20.0)	2 (25.0)
30-d mortality, n (%)	0	0	-	0	0	-
Retrieved nodes, mean ± SD	23.7 ± 6.3	22.7 ± 7.1	0.571	22.0 ± 3.4	23.9 ± 6.4	0.415

BMI: Body mass index; CACI: Charlson Age-Comorbidities Index.

Table 5 Baseline characteristics of included studies in the meta-analysis

Ref.	Year	Country	Type of study	Recruitment period	Level of evidence	2D (%)	3D (%)	Male gender (%)		AGE (yr) (Mean or median)		BMI (Mean or median)		NOS
								2D	3D	2D	3D	2D	3D
Currò et al[37]	2016	Italy	Prospective non randomized Single center	2014-2015	2b	25	25	14 (53.8)	12 (48.0)	68 (43-75)	69 (40-78)	30 (24-35)	31 (23-34)	7
Tao et al[38]	2016	China	Retrospective Single center	2014-2015	2b	31	27	20 (64.5)	16 (59.2)	55 (37-71)	57 (35-74)	23.9 ± 3.6	22.7 ± 4.2	7
Ji et al[34]	2017	China	Retrospective Single center	2015-2017	2b	39	37	27 (69.2)	33 (89.2)	68 ± 4	62 ± 6	NA	NA	6
Su et al[39]	2019	China	Prospective non randomized Single center	2016-2018	2b	54	43	30 (55.6)	29 (67.4)	56.0 ± 10.9	58.3 ± 10.6	23.8 ± 2.9	24.4 ± 3.0	8
Zuccaro et al[40]	2019	Italy	Prospective observational Single center	2015-2018	2b	42	28	NA	NA	69.5 (49-89)	69.25 (48-90)	NA	NA	4
Bracale et al[41]	2020	Italy	Retrospective case matched Two centers	2013-2018	2b	53	53	28 (52.8)	28 (52.8)	68.6 ± 9.5	68.3 ± 11.7	26.7 ± 4.8	26.8 ± 4.7	7

NA: Not available; NOS: Newcastle-Ottawa Scale.

Table 6 Clinico-pathological features of included studies in the meta-analysis

Ref.		Currò et al[37]		Tao et al[38]		Ji et al[34]		Su et al[39]		Zuccaro et al[40]		Bracale et al[41]
n		25	25	31	27	39	37	54	43	42	28	53	53
		2D	3D	2D	3D	2D	3D	2D	3D	2D	3D	2D	3D
Cancer site	Caecum	NA	NA	7 (22.6)	6 (22.2)	NS		NA	NA	NA	NA	21	18
	Ascendingcolon	NA	NA	16 (51.6)	14 (51.9)			33	28	NA	NA	22	17
	Transverse colon	NA	NA	8 (25.8)	7 (25.9)			6	5	NA	NA	10	18
	Descending colon	NA	NA	NA	NA			10	15	NA	NA	NA	NA
Tumour size, cm (mean or median)		NA	NA	5.7 ± 2.4	5.2 ± 2.7	> 3 cm 34 (91.9)	> 3 cm 32 (82.1)	3.5 ± 1.1	3.9 ± 1.9	NA	NA	NA	NA
TNM or T stage, n (%)	0-I	T1-212	T1-210	5 (16.1)	4 (14.8)	NA	NA	5 (9.3)	5 (11.6)	NA	NA	10 (18.8)	13 (24.5)
	II			15 (48.4)	14 (51.9)	NA	NA	20 (37.0)	18 (41.9)	NA	NA	29 (54.8)	27 (51.0)
	III	T3-4 13	T3-4 15	11 (35.5)	9 (33.3)	NA	NA	29 (53.7)	20 (46.5)	NA	NA	14 (26.4)	13 (24.5)
Previous abdominal surgery [Yes, n (%)]		NA	NA	NA	NA	NA	NA	15 (27.8)	11 (25.6)	NA	NA	12 (22.6)	12 (22.6)
Operative time (min) (mean or median)		110 (100–130)	105 (95–120)	152.2 ± 28.9	130.5 ± 27.6	185 ± 22	177 ± 19	127.1 ± 36.6	131.9 ± 42.3	208 (100-350)	167 (95-370)	153.2 ± 52.4	131.0 ± 51.0
Anastomotic time (min)		30 (24-36)	25 (20-28)	ECA	ECA	44 ± 5	38 ± 7	15.0 ± 3.0	13.2 ± 3.0	NS	NS	21.7 ± 6.2	19.2 ± 5.9
Blood loss, mL (mean or median)		NA	NA	84.7 ± 22.3	80.8 ± 29.0	95 ± 35	105 ± 25	48.0 ± 45.5	54.7 ± 48.4	102 (50-500)	53.2 (20-250)	NA	NA
Harvested nodes (mean or median)		NA	NA	19.3 ± 5.6	20.4 ± 5.7	21.5 ± 3.5	19.5 ± 2.5	22.3 ± 9.4	21.1 ± 7.7	23 (11-36)	25 (10-48)	21 ± 7	23 ± 11
Morbidity, n (%)		0	1 (4.0)	3 (9.6)	4 (14.8)	NA	NA	6 (14.0)	6 (11.1)	NA	NA	15 (28.3)	12 (22.6)
Mortality, n (%)		0	0	0	0	NA	NA	0	0	NA	NA	0	0
Time to first flatus (d) (mean or median)		NA	NA	3 (1-4)	3 (1-4)	NA	NA	3.3 ± 0.9	3.1 ± 0.7	NA	NA	2 ± 1	2 ± 1
LOS (d) (mean or median)		NA	NA	9 (6-21)	8 (6-14)	NA	NA	6.6 ± 0.9	6.9 ± 1.1	10.9 (6-51)	9 (6-14)	6 ± 1	6 ± 2

LOS: Length of hospital stay; NA: Not available; ECA: Extracorporeal anastomosis; NS: Not specified.

Table 7 Qualitative description of complications reported in the included studies, n (%)

Patient included	2D, n = 163	3D, n = 148
Postoperative complications
Yes	37 (22.7)	32 (21.6)
No	126 (77.3)	116 (78.4)
Type of complication
Anastomotic bleeding	2 (1.2)	5 (3.3)
Anastomotic leak	4 (2.4)	2 (1.3)
Postoperative anemia	3 (1.8)	3 (2.0)
Canalization delay	12 (7.3)	4 (2.7)
Bowel obstruction	0 (0.0)	1 (0.6)
Wound infection	8 (4.9)	6 (4.0)
Abdominal infection	1 (0.6)	1 (0.6)
Pulmonary	4 (2.4)	4 (2.7)
Other and/or NS	14 (8.5)	14 (9.4)
30-d mortality	2 (1.2)	1 (0.6)