Cranial–caudal–medial approach, counterclockwise complete mesocolic excision in laparoscopic right hemicolectomy

Yao, Zengwu; Wang, Xixun; Zhang, Yifei; Hu, Jinchen; Jian, Mi; Jiang, Lixin

doi:10.1111/codi.16186

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Currently, numerous studies have proposed various approaches for laparoscopic CME surgery improvement in right-side colon cancer. Completely medial access by page-turning approach [ 22 ], retroperitoneal approach [ 23 ], caudal-to-cranial approach [ 24 ], and cranial–caudal–medial counterclockwise approach [ 25 ] have been successively introduced in laparoscopic right hemicolectomy, which could be used as an alternative approach in laparoscopic right hemicolectomy. Luo et al [ 26 ] also developed a new medial approach of vessel management, which focused on vascular dissection in two aspects.…”

Section: Discussionmentioning

confidence: 99%

The concept of developmental anatomy: the greater omentum should be resected in right-sided colon cancer?

Li,

Cao,

et al. 2023

BMC Surg

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Background The greater omentum is derived from the foregut, and the right hemicolon is derived from the midgut based on developmental anatomy. This study aimed to investigate whether the greater omentum should be resected in laparoscopic complete mesocolic excision based on developmental anatomy for right-sided colon cancer. Methods A total of 183 consecutive patients with right-sided colon cancer were recruited in this study between February 2020 and July 2022. Ninety-eight patients underwent standard laparoscopic complete mesocolic excision surgery (CME group). The presence of isolated tumor cells and micrometastases was detected in resected greater omentum by the HE staining and immunohistochemistry analysis. Based on developmental anatomy, laparoscopic CME surgery with greater omentum preservation (DACME group) was proposed and performed on 85 right-sided colon cancer patients. To overcome selection bias, we performed a 1:1 match between two groups using four variables: age, sex, BMI, and ASA scores. Results No isolated tumor cells and micrometastases were found in the resected greater omentum specimen in the CME group. After the propensity score, 81 pairs were balanced and analyzed. Patients in the DACME group showed shorter operative time (194.9 ± 16.4 min vs.201.5 ± 11.5 min, p = 0.002), less blood loss (23.5 ± 24.7 ml vs.33.6 ± 26.3 ml, p = 0.013), and the shorter hospital stays (9.6 ± 1.7 days vs.10.3 ± 2.0 days, p = 0.010) compared with patients in the CME group. In addition, patients in the DACME group had a lower incidence of postoperative complications (4.9% vs.14.8%, p = 0.035) than patients in the CME group. Conclusion The greater omentum should be preserved during right-sided colon cancer surgery, laparoscopic CME surgery based on developmental anatomy is technically safe and feasible for right-sided colon cancer.

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Section: Discussionmentioning

confidence: 99%

The concept of developmental anatomy: the greater omentum should be resected in right-sided colon cancer?

Li,

Cao,

et al. 2023

BMC Surg

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A commentary on “Anatomic patterns and clinical significance of gastrocolic trunk of Henlé in laparoscopic right colectomy for colon cancer: Results of the HeLaRC trial” (Int J Surg. 2022;104:106718)

Luo¹,

Lu²

2022

International Journal of Surgery

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Comparing cranial-caudal-medial and medial–lateral approaches for laparoscopic right hemicolectomy: a propensity score-matched analysis

Wang,

Zhou,

Cheng

et al. 2024

World J Surg Onc

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Background The cranial-caudal-medial approach (CCMA) has been proposed for laparoscopic right hemicolectomy nowadays. This study aimed to investigate the safety and oncological efficacy of CCMA in the treatment of right-sided colon cancer compared to the medial–lateral approach (MLA). Methods Patients diagnosed with right-sided colon cancer were included from February 2015 to June 2018, retrospectively, dividing into the CCMA group and the MLA group. We compared the basic characteristics and the short-term and long-term outcomes in two groups. Results Two hundred and ninety-six patients were included in this study. The baseline characteristics were similar in two groups. Compared with MLA group, CCMA group exhibited shorter operation time (136.3 ± 25.3 min vs. 151.6 ± 21.5 min, P < 0.001), lower estimated blood loss (44.1 ± 15.2 ml vs. 51.4 ± 26.9 min, P = 0.010), and more harvested lymph nodes (18.5 ± 7.1 vs. 16.5 ± 5.7, P = 0.021). The 5-year overall survival (OS) rate for the CCMA group was 76.5%, and the 5-year disease-free survival (DFS) rate was 72.3%, both of which were not inferior to the MLA group. No significant difference was found between two groups in terms of other clinical parameters. Conclusion The CCMA in laparoscopic right hemicolectomy is safe and feasible, making the anatomical plane clearer. This approach can shorten the operation time, reduce intraoperative blood loss, harvest more lymph nodes, and yield satisfactory oncological outcomes.

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Cranial–caudal–medial approach, counterclockwise complete mesocolic excision in laparoscopic right hemicolectomy

Cited by 3 publications

References 9 publications

The concept of developmental anatomy: the greater omentum should be resected in right-sided colon cancer?

The concept of developmental anatomy: the greater omentum should be resected in right-sided colon cancer?

A commentary on “Anatomic patterns and clinical significance of gastrocolic trunk of Henlé in laparoscopic right colectomy for colon cancer: Results of the HeLaRC trial” (Int J Surg. 2022;104:106718)

Comparing cranial-caudal-medial and medial–lateral approaches for laparoscopic right hemicolectomy: a propensity score-matched analysis

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