Regarding: Comparison of Medial-to-Lateral Versus Traditional Lateral-to-Medial Laparoscopic Dissection Sequences for Resection of Rectosigmoid Cancers: Randomized Controlled Clinical Trial

Dear Editor:

We read with great interest the article by Liang et al. ¹ in which the authors analyzed medial-to-lateral versus lateral-to-medial laparoscopic dissection sequences for resection of rectosigmoid cancers. The article indicated that the medial approach was quicker, less expensive, and possibly less invasive; moreover, it gave oncologic results similar to those achieved with the traditional lateral approach. Subsequently, Liang et al. ² conducted a Phase II clinical trial to examine the feasibility and surgical outcomes of the medial-to-lateral laparoscopic dissection approach for the curative resection of right-sided colon cancer and achieved good results. We agree with their conclusion that the medial approach may be the most appropriate procedure for laparoscopic resection of colorectal cancers because their viewpoints have been confirmed by other studies.^3–5

However, we found several statistical errors in the article that may affect the final conclusion. They stated that the number of harvested lymph nodes, incision length, and miscellaneous costs were not significantly different between the medial approach and the lateral approach (P>.05). ¹ But, according to the data they provided, we found that the number of harvested lymph nodes was significantly less (t=3.275, P<.05), the incision length was significantly shorter (t=6.060, P<.05), and the miscellaneous costs were significantly higher (t=3.250, P<.05) in the medial approach group than in the lateral approach group, although a similar number of lymph nodes was retrieved in another randomized controlled trial. ³ The number of harvested lymph nodes is an objective indicator in evaluation of oncological safety of laparoscopic surgery; the fewer number of lymph nodes harvested by laparoscopic surgery with the medial approach will make its oncology security be questioned, and, accordingly, the conclusion of the article will be changed. In addition, the wrong data may mislead our meta-analysis of the medial approach versus the lateral approach in laparoscopic colorectal resection. We would like to share this information with the authors.