Background: We have evaluated the safety and feasibility of combining median-to-lateral and anterior-to-median (MLAM) approaches to perform laparoscopic complete mesocolic excision (CME) with radical lymph node dissection along the gastrocolic trunk of Henle (GTH) for right hemicolon cancer.
Patients and methods: We retrospectively analyzed data obtained from a prospectively maintained database on 31 consecutive patients who had undergone laparoscopic CME with radical lymph node dissection for right hemicolon cancer between January 2010 and December 2013. We used video recordings of the procedure to assess the quality of the surgery and completeness of CME. We also assessed operative data, pathological findings, length of large bowel resected, complications, BMI, operative time by experience of surgeon, and length of hospital stay.
Results: All patients had undergone en bloc resection of the enveloped parietal planes and radical lymph node dissection along the surgical trunk without any serious intraoperative complications. Twenty six and five patients graded mesocolic and intra-mesocolic plane, respectively. Five, three, eleven, and thirteen patients had T1, T2, T3, and T4 tumors, respectively. The median number of lymph nodes retrieved was 25, lymph node metastasis being identified in 11 patients. The mean length of large bowel resected was 21.8 cm. The mean operative time and intraoperative blood loss were 269 min and 39 mL, respectively. No intraoperative complications occurred in any patient. Three patients had postoperative complications. The mean BMI was 22.6 kg/m(2). The mean operative time for patients stratified by BMI of <22 or ≥22 was 225 and 297 min, respectively. There were no correlations with operative time by experience of surgeon. The median postoperative hospital stay was 13 days.
Conclusions: Laparoscopic CME conducted by fusion fascia exposure with radical lymph node dissection along the GTH via a combination of MLAM approaches is a safe and feasible procedure for right hemicolon cancer.