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

Table 1 Baseline characteristics of the patients, n (%)/mean ± SD

Characteristic	Overall	HALS	CLS	RAS	P value	SMD
n	224	35	95	94
Age (years)	58.59 ± 13.73	59.11 ± 12.31	58.58 ± 14.37	58.41 ± 13.70	0.968	0.035
Gender					0.078	0.282
Male	146 (65.2)	17 (48.6)	64 (67.4)	65 (69.1)
Female	78 (34.8)	18 (51.4)	31 (32.6)	29 (30.9)
Body mass index (kg/m2)	22.76 ± 3.09	23.36 ± 4.38	22.53 ± 2.88	22.76 ± 2.71	0.400	0.157
Tumor stage1	220	34	94	92	0.391	0.188
I	26 (11.8)	1 (2.9)	12 (12.8)	13 (14.1)
II	115 (52.3)	20 (58.8)	51 (54.3)	44 (47.8)
III	79 (35.9)	13 (38.2)	31 (32.9)	35 (38.1)
Tumor diameter (cm)	4.50 (3.23–6.00)	4.50 (3.10–5.50)	4.50 (3.50–6.42)	4.50 (3.00–6.00)	0.526	0.193
CEA (ng/mL)	3.18 (1.65–7.96)	2.72 (1.58–6.46)	3.91 (1.71–8.95)	2.77 (1.60–7.48)	0.487	0.052
CA19-9 (ng/mL)	10.89 (6.38–23.04)	12.20(8.25–29.50)	10.40(7.05–14.80)	9.30 (4.94–22.02)	0.310	10.472
CA125 (ng/mL)	12.25 (8.19–19.90)	11.84 (8.50–22.95)	13.00 (9.15–19.08)	12.20 (8.04–9.95)	0.812	0.138
AFP (ng/mL)	2.49 (1.87–3.52)	2.69 (2.33–3.45)	2.44 (1.78–3.19)	1.99 (1.41–2.86)	0.482	6.527
Presence of postoperative complications					0.936	0.043
Yes	35 (15.8)	6 (17.6)	14 (14.9)	15 (16.0)
No	187 (84.2)	28 (82.4)	80 (85.1)	79 (84.0)
Diabetes					0.917	0.053
Yes	36 (16.1)	5 (14.3)	15 (15.8)	16 (17.0)
No	188 (83.9)	30 (85.7)	80 (84.2)	78 (83.0)
Hypertension					0.276	0.216
Yes	56 (25.0)	5 (14.3)	26 (27.4)	25 (26.6)
No	168 (75.0)	30 (85.7)	69 (72.6)	69 (73.4)

¹According to the American Joint Committee on Cancer Staging Manual, 8^th edition.

HALS: Hand-assisted laparoscopic surgery; CLS: Conventional laparoscopic surgery; RAS: Robotic-assisted surgery; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; CA125: Cancer antigen 125; AFP: Alpha-fetoprotein.

Table 2 Specific postoperative complications in three groups of surgical patients, n (%)

	All patients (n = 222), HALS (n1 = 34), CLS (n2 = 94), RAS (n3 = 94)
	Any surgery	HALS	CLS	RAS
Any	35 (15.77)	6 (17.65)	14 (14.89)	15 (15.96)
Incision infection	7 (3.15)	NA	2 (2.13)	5 (5.32)
Hypoproteinemia	7 (3.15)	NA	4 (4.26)	3 (3.19)
Lung infection and pleural effusion	3 (1.35)	1 (2.94)	2 (2.13)	NA
Postoperative atrial fibrillation	3 (1.35)	2 (5.88)	NA	1 (1.06)
Anastomotic fistula	2 (0.90)	NA	NA	2 (2.13)
Stomach paralysis	2 (0.90)	1 (2.94)	NA	1 (1.06)
Intestinal adhesion	2 (0.90)	NA	1 (1.06)	1 (1.06)
hemorrhage	2 (0.90)	NA	2 (2.13)	NA
Urinary tract infection	2 (0.90)	1 (2.94)	1 (1.06)	NA
Abdominal infection	1 (0.45)	NA	NA	1 (1.06)
Bacteremia	1 (0.45)	NA	NA	1 (1.06)
Liver insufficiency	1 (0.45)	NA	1 (1.06)	NA
Delirium	1 (0.45)	NA	1 (1.06)	NA
Renal failure	1 (0.45)	1 (2.94)	NA	NA

HALS: Hand-assisted laparoscopic surgery; CLS: Conventional laparoscopic surgery; RAS: Robotic-assisted surgery; NA: Not available.

Table 3 Short-term postoperative outcomes, mean ± SD/median (25^th-75^th percentiles)

Characteristic	Overall	HALS	CLS	RAS	P value	SMD
n	224	35	95	94
Duration of surgery (min)	177.81 ± 43.04	175.23 ± 36.29	184.10 ± 42.83	172.42 ± 45.12	0.166	0.186
Amount of bleeding (mL)	160.86 ± 132.90	123.71 ± 71.54	162.71 ± 106.99	172.96 ± 168.19	0.172	0.294
Number of lymph nodes cleared	15.00 (11.00–20.00)	17.00 (12.00–21.00)	15.00 (12.00–19.50)	15.00 (10.00–20.00)	0.478	0.213
D1.WC (× 109/L)	9.15 (7.36–11.23)	7.86 (6.30–10.66)	9.47 (7.90–11.07)	9.16 (7.11–11.60)	0.203	0.246
D1.NE (× 109/L)	7.70 (6.06–9.68)	6.30 (4.77–9.51)	7.66 (6.46–9.49)	8.02 (6.15–10.22)	0.210	0.259
D1.LYM (× 109/L)	0.73 (0.53–0.97)	0.74 (0.48–0.92)	0.76 (0.58–1.04)	0.67 (0.53–0.94)	0.247	0.241
D1.CRP (× 109/L)	41.23 (22.65–69.74)	48.72 (24.92–74.72)	42.17 (25.84–71.86)	30.82 (13.54–57.68)	0.348	0.153
D4.WC (× 109/L)	6.66 (5.58–8.25)	5.76 (5.03–7.52)	6.58 (5.47–7.98)	7.27 (6.23–9.44)	0.003	0.427
D4.NE (× 109/L)	5.17 (3.98–6.46)	4.43 (3.27–5.78)	5.03 (3.78–6.06)	5.67 (4.74–7.72)	0.002	0.309
D4.LYM (× 109/L)	0.86 (0.64–1.13)	0.83 (0.66–0.99)	0.92 (0.69–1.22)	0.81 (0.60–1.04)	0.109	0.255
D4.CRP (mg/L)	68.57 ± 38.05	80.11 ± 42.04	59.35 ± 37.05	76.31 ± 34.61	0.084	0.365
Length of postoperative hospital stay (days)	8.00 (7.00–10.00)	7.00 (6.00–8.00)	9.00 (8.00–11.00)	8.00 (7.00–10.00)	< 0.001	0.444
Postoperative recovery time of gastrointestinal function (days)	5.00 (4.00–6.00)	4.00 (3.00–5.00)	5.00 (4.50–6.00)	5.00 (4.00–6.00)	< 0.001	0.597
Duration of postoperative use of pain medication (days)	4.00 (3.00–5.00)	4.00 (3.00–5.00)	4.00 (3.00–5.00)	4.00 (3.00–5.00)	0.248	0.155
Hospitalization costs (USD)	8987.40 ± 2318.62	8214.99 ± 1584.15	8534.28 ± 1513.88	9723.30 ± 2934.85	<0.001	0.452

USD: United States Dollar; HALS; Hand-assisted laparoscopic surgery; CLS: Conventional laparoscopic surgery; RAS: Robotic-assisted surgery; D1: Postoperative day 1; D4: Postoperative day 4; WC: White blood cell; NE: Neutrophil; LYM: Lymphocyte; CRP: C-reactive protein.