A novel and safe approach: middle cranial approach for laparoscopic right hemicolon cancer surgery with complete mesocolic excision

Du, Songtao; Zhang, Bomiao; Liu, Yanlong; Han, Peng; Song, Chengxin; Hu, Fangjie; Xia, Tianyi; Wu, Xiangxin; Cui, Binbin

doi:10.1007/s00464-017-5982-2

Cited by 18 publications

(8 citation statements)

References 25 publications

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“…lon cancer have improved over the last decade [5,6] . Increasing evidence has reported that CMEs contribute to a decreased recurrence rate and increased five-year survival [4,7,8] . At present, a CME is considered to be the standard surgical method for treating colon cancer.…”

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confidence: 99%

Safety and Short-term Efcacy of a Laparoscopic Complete Mesocolic Excision for the Surgical Treatment of Right Hemicolon Cancer

Li¹,

Meng²,

Chen³

2018

Clin Surg Res Commun

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Objective: This study was designed to evaluate the safety and short-term efficacy of a laparoscopic complete mesocolic excision (CME) in patients with right hemicolon cancer. Methods: A total of 88 patients with right hemicolon cancer were retrospectively reviewed. Forty patients underwent laparoscopic CMEs, and 48 patients underwent open CMEs. The clinical data were analyzed and the outcomes were compared between the two groups. Result: There was no significant difference between the laparoscopic CME group and open CME group with regard to the harvested lymph node number (16.60±3.20 vs. 15.33±3.10, respectively, P=0.060), hospital stay length (18.15±5.17 days vs. 17.21±4.47 days, respectively, P=0.360), and postoperative complications (10.0% vs. 10.4%, respectively, P=0.950). The operation time in the laparoscopic CME group (3.02±0.55 hours) was significantly longer than that in the open CME group (2.58±0.50 hours, P=0.004). The time to first flatus (3.28±0.75 days vs 3.92±0.71 days, respectively, P=0.001) and getting out of bed time (1.95±0.75 days vs 3.54±0.71 days, respectively, P=0.001) were both earlier in the laparoscopic CME group than in the open CME group. Conclusion: A laparoscopic CME is a safe and effective minimally invasive surgery for the treatment of right hemicolon cancer.

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confidence: 99%

Safety and Short-term Efcacy of a Laparoscopic Complete Mesocolic Excision for the Surgical Treatment of Right Hemicolon Cancer

Li¹,

Meng²,

Chen³

2018

Clin Surg Res Commun

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“…The concept of CME with CVL is based on the complete removal of the mesentery and the central vascular tie with all lymphnodes draining the tumour area 14,20,21,22 . CME provides superior specimens, acceptable morbidity and improves overall survival 3,17,22,23 .…”

Section: Discussionmentioning

confidence: 99%

“…The concept of CME with CVL is based on the complete removal of the mesentery and the central vascular tie with all lymphnodes draining the tumour area. 14 , 20 , 21 , 22 CME provides superior specimens, acceptable morbidity and improves overall survival. 3 , 17 , 22 , 23 The main difficulty in performing CME plus CVL right hemicolectomy is to identify the gastrocolic trunk of Henle, its anatomic variations and the dissection close to the superior mesenteric vein.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study

Testa

Mazzola

et al. 2021

ANZ Journal of Surgery

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Background To examine the outcome of patients treated with complete mesocolic excision (CME) with central vascular ligation (CVL) after conventional and laparoscopic surgery. Methods We retrospectively evaluated stage I–IV colon adenocarcinoma patients treated by the same surgeon (L.M.) from 2013 to 2018. Postoperative complications, recurrences and survival are assessed. Results Fifty‐one patients (M/F: 24/27) underwent laparoscopic right hemicolectomy with CME (L‐CME) or open CME (O‐CME) plus CVL. Tumour location was the caecum in 39.2% of cases, the transverse in 23.5%, the hepatic colonic flexure in 21.5%, and the ascending colon in 15.6%. Twenty‐four patients underwent L‐CME while 27 underwent O‐CME. More than 15 harvested lymphnodes are reported in 74.1% of O‐CME patients and in 66.7% of L‐CME patients (p = 0.562). Postoperative complications occurred in 7 O‐CME and 5 L‐CME patients, respectively (p = 0.669). Three‐year overall survival, including stage IV, was of 75% versus 77.8% for L‐CME and O‐CME patients, respectively, while for stage I–III, was of 88.9% vs. 80% in L‐CME and O‐CME, respectively (p = 0.440). The median follow‐up was of 2.43 years. Conclusion CME with CVL is a meticulous, complex but feasible technique. In our experience, oncological results in terms of recurrences and overall survival, after conventional and laparoscopic CME plus CVL, are comparable. Patients with stage I–III colon adenocarcinoma have a better prognostic trend especially when more than 15 lymphnodes are removed. The respect of oncological radicality and the correct indication to minimally invasive surgery are the undiscussed key outcome variables.

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“…Multiple studies have shown that the various approaches achieve different advantages for laparoscopic right hemicolectomy. At present, the medial approach (MA) is the most widely accepted approach according to the “no-touch” principle and its safety profile [ 9 – 13 ]. However, the MA in laparoscopic right hemicolectomy is a demanding procedure with a steep learning curve and has a high rate of conversion to laparotomy, mainly because of anatomic complexities and high level of variation in the right colonic vessels [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Tunnel versus medial approach in laparoscopic radical right hemicolectomy for right colon cancer: a retrospective cohort study

Zhang

et al. 2022

BMC Surg

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Purpose This study aimed to explore the feasibility and safety of the tunnel approach in laparoscopic radical right hemicolectomy for colon cancer. Methods From July 2016 to October 2018, a total of 106 consecutive patients with colon cancer who underwent laparoscopic radical right hemicolectomy at the Affiliated Cancer Hospital of Zhengzhou University were enrolled. The patients were stratified into either a tunnel approach (TA) (n = 56) group or traditional medial approach (MA) (n = 50) group according to the surgical technique performed. The baseline demographics, perioperative outcomes and oncologic outcomes were compared between the two groups. Results The baseline characteristics did not differ between groups. The TA group had significantly less blood loss [20.0 (10.0–40.0) vs. 100 (100.0–150.0) ml, p < 0.001] and a shorter operation time [128.4 ± 16.7 vs. 145.6 ± 20.3 min, p < 0.001] than the MA group. The time to first flatus and postoperative hospital stay were similar [3.0 (2.0–4.0) vs. 3.0 (3–4.0) days, p = 0.329; 10.4 ± 2.6 vs. 10.7 ± 3.0 days, p = 0.506] between the two groups. The conversion to laparotomy and complication rates were similar between groups (0 vs. 6.0%, p = 0.203; 14.3% vs. 18.0%, p = 0.603, respectively). No treatment-related deaths occurred in either group. The TA group did not have significantly better survival outcomes than the MA group (p = 0.372). Conclusions The TA seems to allow for more favourable results in terms of blood loss and operative time than the MA, with similar results regarding time to first flatus, hospital stay, postoperative complication rate, conversion rate and oncologic outcomes; moreover, the TA is easier for beginners to master.

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A novel and safe approach: middle cranial approach for laparoscopic right hemicolon cancer surgery with complete mesocolic excision

Abstract: Our study showed that radical resection of right-sided colon cancer using the MCA was safe and feasible for the treatment of colorectal cancer patients.

Cited by 18 publications

References 25 publications

Safety and Short-term Efcacy of a Laparoscopic Complete Mesocolic Excision for the Surgical Treatment of Right Hemicolon Cancer

Safety and Short-term Efcacy of a Laparoscopic Complete Mesocolic Excision for the Surgical Treatment of Right Hemicolon Cancer

Laparoscopic and open complete mesocolic excision with central vascular ligation for right colonic adenocarcinoma: a retrospective comparative study

Tunnel versus medial approach in laparoscopic radical right hemicolectomy for right colon cancer: a retrospective cohort study

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