Improved Nodal Harvest with Intra-Corporeal Mesentery Dissection in Laparoscopic Right Hemicolectomy: A Retrospective Study

Abstract

Background Right-sided colon cancer is now commonly treated by laparoscopic right hemicolectomy (LRH). The best procedure for mesentery dissection and nodal harvesting is still being debated. The purpose of this research is to compare intra-corporeal mesentery dissection (ICMD) with extra-corporeal mesentery dissection (ECMD) approaches and assess their impact on nodal harvest during LRH. Methods A retrospective analysis of 78 operative cases of LRH was performed. The patients were divided into two groups: those with ICMD (n = 30) and those with ECMD (n = 48). The total number of lymph nodes extracted was the primary outcome. The number of positive lymph nodes, length of hospital stay, and surgical complications were some of the secondary objectives. Results The total number of lymph nodes extracted in the ICMD was considerably higher (p = 0.02). Cancers located in the ascending colon were associated with more lymph nodes than tumours located in the cecum or hepatic flexure (p0.001). The two groups did not differ significantly regarding the median number of positive lymph nodes or length of hospital stay. Conclusion This study demonstrates that ICMD provides improved nodal yield compared to ECMD in LRH for right-sided colon cancer. Tumor location also impacts the nodal yield, with tumors in the ascending colon having the highest yield. Understanding the optimal mesentery dissection technique and nodal harvest can help improve the oncological outcomes. The use of robotic surgical equipment may further enhance the ICMD approach, especially for accessing retroperitoneal structures.