title: Laparoscopic right colectomy vs laparoscopic-assisted colonoscopic polypectomy for endoscopically unresectable polyps: a randomized controlled trial.
abstract: OBJECTIVE
  A randomized controlled trial (RCT) was conducted to test the null hypothesis that there is no difference in complication rates and length of stay (LOS) between laparoscopic right colectomy (LRC) and laparoscopic-assisted colonoscopic polypectomy (LACP) for endoscopically unresectable polyps of the right colon.
  
  
  METHODS
  A single-centre RCT (NCT01986699) was conducted on patients with polyps of the right colon deemed by the gastroenterologist to be unresectable. Patients underwent a repeat colonoscopy with biopsy by an interventional endoscopist and were allocated to LRC or LACP. Patients with a nonlift sign, dysplasia, adenocarcinoma, inflammatory bowel disease or familial adenomatous polyposis were excluded from the trial. The study was powered to detect a 73% difference in the LOS which required 17 patients in each arm with an α error of 0.05 and a power of 95%.
  
  
  RESULTS
  Thirty-four patients were comparable for age (P = 0.919), gender (P = 0.364), body mass index (P = 0.634), American Society of Anesthesiologists class (P = 0.388) and previous abdominal surgery (P = 0.366). There was no significant difference in the preoperative morphology (P = 0.485), location (P = 0.297), size (P = 0.690) or histology of the polyps (P = 0.779). LRC patients experienced a longer operating time (180 vs 90 min; P = 0.001), required more intravenous infusion (3.1 vs 2.0 l; P = 0.025), took significantly longer to pass flatus (2.88 vs 1.44 days; P < 0.001), resumed solid food later (3.94 vs 1.69 days; P < 0.001) and had a longer postoperative LOS (4.94 vs 2.63 days; P < 0.001). Postoperative complications (P = 0.656), readmissions (P = 0.5) and reoperations (P = 0.5) did not differ. Final size (P = 0.339) and histology (P = 0.104) of the polyps did not differ. There were four cancers in the LRC arm. At follow-up colonoscopy with biopsy of the scar in 10 patients at 15.3 months, one patient had recurrence of the polyp at the site of the previous LACP.
  
  
  CONCLUSIONS
  LACP and LRC had similar complication rates, but LOS was shorter after LACP.
authors.affiliation: Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors.forename: C
authors.initials: C
authors.lastname: Lascarides
authors.affiliation: Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Buscaglia
authors.affiliation: Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA.
authors.forename: P I
authors.initials: PI
authors.lastname: Denoya
authors.affiliation: Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nagula
authors.affiliation: Divisions of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Bucobo
authors.affiliation: Colon and Rectal Surgery, State University of New York, Stony Brook, New York, USA. rcmbergamaschi@gmail.com.
authors.forename: R
authors.identifier: http://orcid.org/0000-0001-9993-0563
authors.initials: R
authors.lastname: Bergamaschi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000473:pathology / Q000601:surgery; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
keywords:  length of stay; Laparoscopic-assisted colonoscopic polypectomy (LACP); complication rates; laparoscopic right colectomy (LRC)