Skip to main content

Advertisement

Log in

Laparoscopic right hemicolectomy with complete mesocolic excision

Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Complete mesocolic excision (CME) has recently been reemphasized as a technical approach for anatomical dissection during colon cancer surgery. Although a laparoscopic approach for right colon cancer is performed frequently, identifying an adequate dissection plane is not always easy. In our practice, the patient lies in a modified lithotomy position. The first step is ileocolic area mobilization, followed by adequate retraction of the cecum laterally. This procedure enables discrimination of the ileocolic vessels and superior mesenteric vessels. Importantly, this method facilitates identification of the superior mesenteric vein (SMV), followed by the identification of the root of ileocolic pedicles. After that, sharp dissection along the SMV in an upward direction helps to safely identify the middle colic artery (MCA). Dissection then continues to the level of the origin of MCA, after which the right branch of MCA can be divided.

Methods

A total of 128 consecutive patients (63 males) who underwent laparoscopic CME for right colon cancer by a single surgeon were analyzed in this study.

Results

There was no conversion to open surgery. The median operation time was 192 min (interquartile range [IQR] 118–363 min). The median proximal and distal resection margins were 11 and 10 cm, respectively. The median number of harvested lymph nodes was 28 (IQR 3–88). There were six postoperative complications (4.6 %). The median hospital stay was 5 days (IQR 4–37 days). The video demonstrates a laparoscopic CME for a patient who had advanced distal ascending colon cancer.

Conclusion

In conclusion, identifying the anatomical location of the SMV and performing meticulous dissection along the SMV is an essential procedure for containing all potential routes of metastatic tumors. Initial ileocecal mobilization with adequate counter traction of the cecum may be useful for novice surgeons attempting to identify the location of SMV during laparoscopic CME for right colon cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616

    Article  CAS  PubMed  Google Scholar 

  2. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    Article  CAS  PubMed  Google Scholar 

  3. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis 11:354–364 (discussion 364–355)

    Article  CAS  PubMed  Google Scholar 

  4. Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Neuenschwander AU, Vilandt J (2011) Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Colorectal Dis 13:1123–1129

    Article  CAS  PubMed  Google Scholar 

  5. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278

    Article  PubMed  Google Scholar 

  6. West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865

    Article  PubMed  Google Scholar 

  7. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769

    Article  PubMed  Google Scholar 

  8. COST (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  9. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  10. Rea JD, Cone MM, Diggs BS, Deveney KE, Lu KC, Herzig DO (2011) Utilization of laparoscopic colectomy in the United States before and after the clinical outcomes of surgical therapy study group trial. Ann Surg 254:281–288

    Article  PubMed  Google Scholar 

  11. Schwab KE, Dowson HM, Van Dellen J, Marks CG, Rockall TA (2009) The uptake of laparoscopic colorectal surgery in Great Britain and Ireland: a questionnaire survey of consultant members of the ACPGBI. Colorectal Dis 11:318–322

    Article  CAS  PubMed  Google Scholar 

  12. Alnasser M, Schneider EB, Gearhart SL, Wick EC, Fang SH, Haider AH, Efron JE (2013) National disparities in laparoscopic colorectal procedures for colon cancer. Surg Endosc 28(1):49–57

    Article  PubMed  Google Scholar 

  13. Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, Ma JJ, Li JW, Zang L, Han DP, Zheng MH (2012) Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc 26:3669–3675

    Article  PubMed  Google Scholar 

  14. Adamina M, Manwaring ML, Park KJ, Delaney CP (2012) Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc 26:2976–2980

    Article  PubMed  Google Scholar 

  15. Liang JT, Lai HS, Huang KC, Chang KJ, Shieh MJ, Jeng YM, Wang SM (2003) Comparison of medial-to-lateral versus traditional lateral-to-medial laparoscopic dissection sequences for resection of rectosigmoid cancers: randomized controlled clinical trial. World J Surg 27:190–196

    Article  PubMed  Google Scholar 

  16. Poon JT, Law WL, Fan JK, Lo OS (2009) Impact of the standardized medial-to-lateral approach on outcome of laparoscopic colorectal resection. World J Surg 33:2177–2182

    Article  PubMed  Google Scholar 

  17. Hasegawa S, Kawamura J, Nagayama S, Nomura A, Kondo K, Sakai Y (2007) Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers. Surg Endosc 21:1657

    Article  PubMed  Google Scholar 

  18. Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH (2007) Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg 11:778–782

    Article  PubMed  Google Scholar 

  19. Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB III, Cummings B, Gunderson L, Macdonald JS, Mayer RJ (2001) Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19:157–163

    CAS  PubMed  Google Scholar 

  20. Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Jeonghyun Kang, Im-kyung Kim, Sung Il Kang, Seung-Kook Sohn and Kang Young Lee have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kang Young Lee.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (WMV 144519 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kang, J., Kim, Ik., Kang, S.I. et al. Laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc 28, 2747–2751 (2014). https://doi.org/10.1007/s00464-014-3521-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3521-y

Keywords

Navigation