Method of pedicle division during laparoscopic right hemicolectomy affects lymph node yield and short‐term outcomes

Pal, Atanu; Stearns, Adam T.; Kapur, Sandeep; Speakman, C. T. M.; Wharton, Richard; Shaikh, Irshad; Hernon, James

doi:10.1111/ans.14504

Cited by 1 publication

(3 citation statements)

References 14 publications

(21 reference statements)

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“…Short‐term complications including hemorrhage, ileus, anastomotic leak, and surgical site infections were similar between the two groups; the median length of stay was more or less similar. While a previous study [5] demonstrated a higher incidence of postoperative ileus in the intracorporeal group, this was not confirmed by our study. This difference might be associated with the wide adoption of enhanced recovery after surgery program in our department.…”

Section: Discussioncontrasting

confidence: 99%

“…Indeed, intracorporeal vessel ligation was associated with more extensive colon excisions according to our results. This finding is consistent with a previous study by Pal et al [5] who reported a higher lymph node yield with intracorporeal vessel ligation in right colon surgery.…”

Section: Discussionsupporting

confidence: 94%

“…Several technical variations of surgery for right colon cancer have been described [2], including both intracorporeal and extracorporeal ligation/division of the vascular pedicle. Pal et al [5] suggested that the intracorporeal approach has been associated with greater lymph node harvest than the extracorporeal technique. Therefore, this study aimed to compare the two vessel ligation techniques relative to pathological outcomes, short‐term post‐operative morbidity, local recurrence, and distant metastases.…”

Section: Introductionmentioning

confidence: 99%

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Intracorporeal Vessel Ligation in Laparoscopic Right Colectomy for Cancer is Associated with Increased Lymph Node Yield

Garoufalia,

Emile,

Gefen

et al. 2023

World j. surg.

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Background This study aimed to compare intra-and extracorporeal division of the vascular pedicle in laparoscopic right colectomy regarding pathological outcomes, short-term morbidity, and local recurrence and distant metastases. Methods Retrospective analysis of an IRB-approved database of all patients who underwent laparoscopic right colectomy for cancer between 01/2011 and 08/2021. Main outcome measures were number of harvested lymph nodes, length of resected colon, R1 rate, positive lymph node ratio, short-term post-operative morbidity, local recurrence, and distant metastases. Results Two-hundred seventy-one consecutive patients (136 males) patients underwent laparoscopic right hemicolectomy for cancer during the study period. Vessel ligation was intracorporeal in 171 (63%) and extracorporeal in 100 patients (37%); groups had similar baseline characteristics except for extent of resection as extended right hemicolectomy was significantly more often performed in the intracorporeal group. When the two groups were matched for the extent of resection (standard versus extended right hemicolectomy), the mean number of harvested lymph nodes (28.61 ± 12.04 versus 25.37 ± 10.06, p = 0.04) and median length of the resected colon [26.00 (IQR: 21.00, 32.00) versus 23.00 (IQR: 19.00, 27.00) cm, p = 0.003] were significantly higher in the intracorporeal than in the extracorporeal group. The intracorporeal group required a significantly longer operative time than did the extracorporeal group (168.94 ± 57.9 vs. 139.7 ± 41.3 mins, p = 0.001). No significant differences were noted between the groups in terms of ileus, hemorrhage, surgical site infection, re-operation rates, recurrence, or distant metastases. Conclusion Intracorporeal vessel ligation in laparoscopic right hemicolectomy was associated with increased lymph node yield and longer specimens, although requiring longer operative times. Postoperative clinical outcomes were similar to outcomes in the extracorporeal ligation group.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 94%