Laparoscopic complete mesocolic excision for right colon cancer

Abstract

Background. To treat colon cancer via complete meso-colic excision (CME) with central vascular ligation (CVL), dissection along the embryologic fusion planes is required. However, this surgery is difficult, especially for right-sided colon cancer, because the anatomy and embryology of the transverse mesocolon are not familiar to gastrointestinal surgeons. Methods. In this video article, the anatomic details of the transverse mesocolon based on embryology are illustrated with a focus on the venous anatomy. Dissection of the transverse mesocolon along the embryologic planes using a cranial approach during laparoscopic right hemicolectomy also is presented. Results. During the development of the primitive gas-trointestinal tract, the transverse mesocolon locates between the terminal portion of the midgut and the beginning of the hindgut. After 270° counterclockwise rotation of the primary intestinal loop, the transverse mesocolon fuses with the frontal surface of the duodenum and pancreas. Simultaneously, the greater omentum hangs down from the greater curvature of the stomach in front of the transverse colon and fuses with the transverse meso-colon. Moreover, the drainage vein of the right colon sometimes joins the right gastroepiploic vein, and the gastrocolic trunk is formed. Anatomic complexity of the transverse mesocolon is caused by rotation and fusion of the gastrointestinal tract during embryologic development. Conclusions. Knowledge concerning these embryologic peculiarities of the transverse mesocolon should be useful in the performance of laparoscopic CME with CVL for right-sided colon cancer. Electronic supplementary material The online version of this article (

Short-Term and Long-Term Outcomes of Complete Mesocolic Excision with Central Vascular Ligation for Ascending Colon Cancer: Single Institution

“…The mean operation time in the present study was found to191.6min. The means of the length of hospital stay (13.9 days), time to sips of water (4.7 days), time to soft diet (7.7 days), and blood loss (85.6 ml) in the present study were similar to those reported in previous studies [18][19][20][21]. Specimens were collected most often from the correct anatomical plane in colon cancer resection (92% vs. 40%, p<0.0001) and had a higher number of harvested lymph nodes (30 vs. 18, p<0.0001) than non-CME specimens [7].…”

“…The most commonly occurring complications were found to be ileus and wound dehiscence. The mean operation time of CME in previous studies ranged from 136-269 min, and no significant differences were reported between open and laparoscopic surgeries [21,22]. The mean operation time in the present study was found to191.6min.…”

“…Several previous studies reported that the rate of post-operative morbidity after CME ranges from 5.7-19.7% [6,11,[18][19][20]. In the present study, the total post-operative complication rate was found to be 23.1%.…”

“…Specimens were collected most often from the correct anatomical plane in colon cancer resection (92% vs. 40%, p<0.0001) and had a higher number of harvested lymph nodes (30 vs. 18, p<0.0001) than non-CME specimens [7]. Several studies reported that the mean number of harvested lymph nodes in CME with CVL for right colon cancer ranged from 28-35.4 for open CME and 19-34.4 for laparoscopic CME [21][22][23][24]. The mean number of harvested lymph nodes in the present study was 30.3.…”

Laparoscopic Complete Mesocolic Excision via Reduced Port Surgery for Treatment of Colon Cancer

“…The procedure is also oncologically safe for treating patients with colon cancer [3,4]. Complete mesocolic excision with central vascular ligation has been found to standardize colon cancer surgery, reduce local recurrence, and improve long-term survival [5,6], and the feasibility and safety of complete mesocolic excision in open and laparoscopic surgery have been demonstrated [7,8,9,10,11,12]. …”