Right hemicolectomy with central vascular ligation in colon cancer

Weber, Klaus; Hohenberger, Werner

doi:10.1007/s00464-011-1849-0

Cited by 12 publications

(12 citation statements)

References 3 publications

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“…There is, therefore, substantial reason to believe the resection described above includes a significant segment of the SMP (Fig.1). The consequences of this denervation are not yet fully understood [4].…”

Section: Introductionmentioning

confidence: 99%

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

et al. 2016

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“…Unlike us though, they did not find the expected accelerated transit which by many was considered to be the cause of chronic intractable postoperative diarrhea. 9 What makes our study different from Johnson's (apart from the fact that ours is on humans) is that we examined the whole SB (not only jejunum) with a preserved SB continuity (only extrinsic denervation). In the same canine model with only intrinsic denervation (transection and reanastomosis of the SB), Johnson et al reported a reduced transit rate, making it plausible that the bowel transection could provide one explanation for our different findings concerning the transit time.…”

Section: Discussionmentioning

confidence: 89%

“…When D3 extended mesenterectomy was introduced, there was widespread skepticism about the procedure due to a concern that chronic intractable postoperative diarrhea might occur. 9 The fear turned out to be unfounded. A study compared the quality of life and bowel habits (at least 6 mo after surgery) between two groups of patients undergoing right colectomy with and without extrinsic denervation, 19 presenting a moderate increase of 0.48 stools per day (P ¼ 0.02) was in the denervated group when compared with the control group.…”

Section: Discussionmentioning

confidence: 99%

“…Authors have registered chronic intractable diarrhea in patients, due to loss of the dampening effect of the sympathetic nerves. 9 These reports are mostly based on poor-quality clinical data on patients who have received various additional procedures or treatments possibly contributing to the symptoms, such as bowel transection, pancreas resection, bowel segment resection or bypass, ischemia/reperfusion injury, postoperative chemotherapy, and graft rejection.…”

Section: Introductionmentioning

confidence: 99%

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Bowel Motility After Injury to the Superior Mesenteric Plexus During D3 Extended Mesenterectomy

Thorsen

Štimec

Lindstrøm

et al. 2019

Journal of Surgical Research

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Background: Improvement of lymphadenectomy in right colectomy requires removal of all tissue surrounding the superior mesenteric vessels beneath the pancreatic notch. Shortand long-term bowel motility disorders after D3 extended mesenterectomy with consecutive superior mesenteric plexus transection are studied. Methods: Patients without pre-existing motility disorders undergoing D3 extended mesenterectomy were examined 3 times using the wireless motility capsule: before, at 3 wk, and 6 mo after surgery. Segmental transit times and contractility were analyzed using mixed effect modeling. Correlation between contractility and transit time was assessed by the Pearson correlation coefficient. Results: Fifteen patients (4 men), with median age 62 y, were included. Mean values for the three consecutive examinations are as follows. Gastric transit time increased from 237 to 402 and 403 min, respectively. Small bowel transit time decreased from 246 to 158 (P < 0.01) and 199 (P ¼ 0.03) min, respectively. Colonic transit time decreased from 1742 to 1450 and 1110 (P ¼ 0.02) min, respectively. Gastric contractions per minute (CPM) varied from 1.73 to 1.05 (P ¼ 0.01) and 2.47 (P < 0.01), respectively. Small bowel CPM decreased from 3.43 to 2.68 and 3.34, respectively. Colonic CPM ranged from 1.59 to 1.45 and 1.91 (P ¼ 0.08), respectively. Correlation between small bowel (SB) transit time and CPM was À0.45 (P ¼ 0.09) preoperatively, and À0.03 (P ¼ 0.91) 6 mo postoperatively. Conclusions: Extrinsic SB denervation leads to significantly accelerated SB transit, reduced contractility, and disturbed correlation between transit time and contractility early after denervation. Both number of contractions and transit time in the denervated SB show a clear tendency toward normalization at 6 mo.

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Reply to: Right hemicolectomy with central vascular ligation in colon cancer

et al. 2011

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We thank Doctors Weber and Hohenberger for their kind comments [1]; however, we would like to stress some points of interest. The variance of colon arterial anatomy is an established fact and has been well pointed out that it can be due to definitions used, population examined, or methodology [2]. The numbers are not crucial; it is more important that the surgeon be aware of the individual variants, especially those that can complicate surgical procedures. We also have had the impression that the right colic artery is not found at surgery as often as with radiology. On occasion, a right colic artery seen at preoperative MDCT angiography was of such a small caliber that it could be successfully cauterized at surgery. However, this does not imply that there are no lymph nodes or vessels in its vicinity. Moreover, there are data in the literature about metastasis in cecal and ascending colon cancer to the central ileocolic, right colic, and middle colic nodes at rates of 11.1, 5.0, and 6.1%, respectively [3]. This becomes even more important in light of recent data suggesting that patients with micrometastasis and isolated cancer cells within harvested lymph nodes (found in 5–26% of negative nodes) have lower survival rates [4]. This is why we have started a randomized controlled trial (ClinicalTrials.gov) to study safe D3 resection in right-sided colon cancer through the help of preoperative MDCT angiography. Our operative technique for D3 resection (or CME) differs somewhat from that of Hohenberger et al. [5]. A medial approach is generally preferred in Norway. Dissection begins by dividing the visceral peritoneum over the terminal ileal vein and opening the vascular sheath of the superior mesenteric vein (SMV). The dissection continues toward the left-hand side of the superior mesenteric artery, and then cranially, following it to the level of the gastrocolic trunk. This is simultaneously followed (in the operating room) by a 3D reconstruction of the vessels using the Osirix software mentioned in our article (Fig. 1). The fatty tissue is dissected from the SMV toward the patient’s right side; the ileocolic and right colic arteries are found (when present) and divided at their origin. The middle colic artery is not divided, but the fatty tissue around the origin of the middle colic artery is removed, dissecting it toward the right side of the patient and keeping the specimen intact and en bloc. The right branch of the middle colic artery is divided. The arteries are drawn toward the right-hand side of the SMV anterior or posterior depending on their position, and the right colic vein is divided at its confluence with the gastrocolic trunk. We have a vascular surgeon present in this segment of the procedure (SK). Lateral mobilization of the devascularized specimen is then performed. If the dissection is done in this manner, one will notice a gutter toward the vena cava that is lifted together with the mesocolon. The resection of the vascular sheath posterior to the SMV is performed last. Finally, we would like to s...

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Right hemicolectomy with central vascular ligation in colon cancer

Cited by 12 publications

References 3 publications

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

Bowel Motility After Injury to the Superior Mesenteric Plexus During D3 Extended Mesenterectomy

Reply to: Right hemicolectomy with central vascular ligation in colon cancer

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