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Initial retrocolic endoscopic tunnel approach (IRETA) for complete mesocolic excision (CME) with central vascular ligation (CVL) for right colonic cancers: technique and pathological radicality

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Abstract

Introduction

The concept of complete mesocolic excision (CME) with central vascular ligation (CVL) for treatment of right colon cancer evolved over last one decade. It decreases local recurrences and improves the survival rates. We describe our novel technique which involves first posterior sharp dissection between planes of parietal and visceral fascia of mesocolon followed by ligation of ileocolic, right colic and middle colic pedicles at their origin. We highlight the technical variations with various techniques and advantages over conventional medial to lateral approach in current study.

Aim

The outcomes were measured in terms of technical feasibility, short-term outcomes and pathological radicality of current laparoscopic technique (IRETA) for CME with CVL.

Materials and methods

Two hundred twelve patients (163 males) who underwent laparoscopic CME for right colon cancer over the period of January 2009 to December 2013 were analysed via prospectively maintained database.

Results

97.16 % of patients (n = 206) underwent laparoscopic CME while six patients required open conversion. Mean operative time was 142 ± 28.4 min with median hospital stay of 5 days (range 4–11). The median count of lymph node harvested were 24 (range 10–42). The complete mesocolic excision plane was achieved in 93.8 % patients. 84.4 % (n = 179) of our patients were having (T3, N+) disease on pathological examination. The overall morbidity (<30 days) was 9.9 %.

Conclusion

Laparoscopic initial retrocolic endoscopic tunnel approach (IRETA) for CME with CVL in right colonic cancers is safe, simpler and feasible laparoscopic approach with minimal complications. Creation of retro colic tunnel is key highlight of IRETA approach. This approach becomes especially useful in patients with late presentations where complete mesocolic excision remains essential to enhance oncological radicality as per evidence available.

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Acknowledgments

The technique was presented by Palanivelu C et al. Initial retrocolic endoscopic tunnel approach: IRETA—for laparoscopic right colectomy in malignant disease presented at ELSA 2006 as an oral presentation (Endoscopic and Laparoscopic Surgeons of Asia Congress at Seoul, South Korea, October 18 to 21, 2006). The current study ‘Initial Retrocolic Endoscopic Tunnel Approach [IRETA] With Complete Mesocolic Excision [CME] For Right Colonic Cancers: Technique, Pathological Radicality and short term outcomes’ was presented as an oral presentation at (Indian association of surgical gastroenterology) IASG 2014 at Ahmedabad, October 2 to 5, 2014.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, GEM Hospital and Research Center, 45/A Pankaja mill road, Ramanathapuram, Coimbatore, India, 641045

    Rajapandian Subbiah, Saurabh Bansal, Manish Jain, Parthasarthi Ramakrishnan, Senthilnathan Palanisamy, Praveen Raj Palanivelu & Palanivelu Chinusamy

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  1. Rajapandian Subbiah
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  2. Saurabh Bansal
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  3. Manish Jain
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  4. Parthasarthi Ramakrishnan
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  5. Senthilnathan Palanisamy
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  6. Praveen Raj Palanivelu
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  7. Palanivelu Chinusamy
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Correspondence to Saurabh Bansal.

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Subbiah, R., Bansal, S., Jain, M. et al. Initial retrocolic endoscopic tunnel approach (IRETA) for complete mesocolic excision (CME) with central vascular ligation (CVL) for right colonic cancers: technique and pathological radicality. Int J Colorectal Dis 31, 227–233 (2016). https://doi.org/10.1007/s00384-015-2415-3

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  • DOI: https://doi.org/10.1007/s00384-015-2415-3

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