Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

We have evaluated the safety and feasibility of combining median-to-lateral and anterior-to-median (MLAM) approaches to perform laparoscopic complete mesocolic excision (CME) with radical lymph node dissection along the gastrocolic trunk of Henle (GTH) for right hemicolon cancer.

Patients and methods

We retrospectively analyzed data obtained from a prospectively maintained database on 31 consecutive patients who had undergone laparoscopic CME with radical lymph node dissection for right hemicolon cancer between January 2010 and December 2013. We used video recordings of the procedure to assess the quality of the surgery and completeness of CME. We also assessed operative data, pathological findings, length of large bowel resected, complications, BMI, operative time by experience of surgeon, and length of hospital stay.

Results

All patients had undergone en bloc resection of the enveloped parietal planes and radical lymph node dissection along the surgical trunk without any serious intraoperative complications. Twenty six and five patients graded mesocolic and intra-mesocolic plane, respectively. Five, three, eleven, and thirteen patients had T1, T2, T3, and T4 tumors, respectively. The median number of lymph nodes retrieved was 25, lymph node metastasis being identified in 11 patients. The mean length of large bowel resected was 21.8 cm. The mean operative time and intraoperative blood loss were 269 min and 39 mL, respectively. No intraoperative complications occurred in any patient. Three patients had postoperative complications. The mean BMI was 22.6 kg/m2. The mean operative time for patients stratified by BMI of <22 or ≥22 was 225 and 297 min, respectively. There were no correlations with operative time by experience of surgeon. The median postoperative hospital stay was 13 days.

Conclusions

Laparoscopic CME conducted by fusion fascia exposure with radical lymph node dissection along the GTH via a combination of MLAM approaches is a safe and feasible procedure for right hemicolon cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  2. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  3. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Colon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  PubMed  Google Scholar 

  4. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7

    Article  PubMed  Google Scholar 

  5. Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250:54–61

    Article  PubMed  Google Scholar 

  6. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ, Colon Cancer Laparoscopic or Open Resection Study Group (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  PubMed  Google Scholar 

  7. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation: technical notes and outcome. Colorectal Dis 11:354–364

    Article  CAS  PubMed  Google Scholar 

  8. West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865

    Article  PubMed  Google Scholar 

  9. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28:272–278

    Article  PubMed  Google Scholar 

  10. Bertelsen CA, Bols B, Ingeholm P, Jansen JE, Neuenschwander AU, Vilandt J (2011) Can the quality of colonic surgery be improved by standardization of surgical technique with complete mesocolic excision? Colorectal Dis 13:1123–1129

    Article  CAS  PubMed  Google Scholar 

  11. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769

    Article  PubMed  Google Scholar 

  12. Gouvas N, Pechlivanides G, Zervakis N, Kafousi M, Xynos E (2012) Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Colorectal Dis 14:1357–1364

    Article  CAS  PubMed  Google Scholar 

  13. Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, Ma JJ, Li JW, Zang L, Han DP, Zheng MH (2012) Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc 26:3669–3675

    Article  PubMed  Google Scholar 

  14. Adamina M, Manwaring ML, Park KJ, Delaney CP (2012) Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc 26:2976–2980

    Article  PubMed  Google Scholar 

  15. Takemasa I, Uemura M, Nishimura J, Mizushima T, Yamamoto H, Ikeda M, Sekimoto M, Doki Y, Mori M (2013) Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: a prospective case-control comparison. Surg Endosc 28(4):1110–1118.

  16. Feng B, Ling TL, Lu AG, Wang ML, Ma JJ, Li JW, Zang L, Sun J, Zheng MH (2013) Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer. Surg Endosc 28(2):477–483

  17. Storli KE, Søndenaa K, Furnes B, Eide GE (2013) Outcome after introduction of complete mesocolic excision for colon cancer is similar for open and laparoscopic surgical treatments. Dig Surg 30:317–327

    Article  PubMed  Google Scholar 

  18. Galizia G, Lieto E, De Vita F, Ferraraccio F, Zamboli A, Mabilia A, Auricchio A, Castellano P, Napolitano V, Orditura M (2014) Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study. Int J Colorectal Dis J 29:89–97

    Article  Google Scholar 

  19. Shinohara H, Kurahashi Y, Kanaya S, Haruta S, Ueno M, Udagawa H, Sakai Y (2013) Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery. Gastric Cancer 16:615–620

    Article  CAS  PubMed  Google Scholar 

  20. Sadler TW (2009) Langman’s medical embryology, 11th edn. Lippincott, Baltimore

    Google Scholar 

  21. Jeong YJ, Cho BH, Kinugasa Y, Song CH, Hirai I, Kimura W, Fujimiya M, Murakami G (2009) Fetal topohistology of the mesocolon transversum with special reference to fusion with other mesenteries and fasciae. Clin Anat 22:716–729

    Article  PubMed  Google Scholar 

  22. Kobayashi H, Enomoto M, Higuchi T, Uetake H, Iida S, Ishikawa T, Ishiguro M, Kato S, Sugihara K (2011) Clinical significance of lymph node ratio and location of nodal involvement in patients with right colon cancer. Dig Surg 28:190–197

    Article  PubMed  Google Scholar 

  23. Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81:503–508

    CAS  PubMed Central  PubMed  Google Scholar 

  24. Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342

    PubMed Central  PubMed  Google Scholar 

  25. Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268

    Article  PubMed Central  PubMed  Google Scholar 

  26. Gundara JS, Gill AJ, Hugh TJ, Samra JS (2013) Redefining the apical lymph node at right hemicolectomy. Eur J Surg Oncol 39:662–665

    Article  CAS  PubMed  Google Scholar 

  27. Ignjatovic D, Spasojevic M, Stimec B (2010) Can the gastrocolic trunk of Henle serve as an anatomical landmark in laparoscopic right colectomy? A postmortem anatomical study. Am J Surg 199:249–254

    Article  PubMed  Google Scholar 

  28. Jin G, Tuo H, Sugiyama M, Oki A, Abe N, Mori T, Masaki T, Atomi Y (2006) Anatomic study of the superior right colic vein: its relevance to pancreatic and colonic surgery. Am J Surg 191:100–103

    Article  PubMed  Google Scholar 

  29. Ignjatovic D, Stimec B, Finjord T, Bergamaschi R (2004) Venous anatomy of the right colon: three-dimensional topographic mapping of the gastrocolic trunk of Henle. Tech Coloproctol 8:19–21

    Article  CAS  PubMed  Google Scholar 

  30. Ogino T, Takemasa I, Horitsugi G, Furuyashiki M, Ohta K, Uemura M, Nishimura J, Hata T, Mizushima T, Yamamoto H, Doki Y, Mori M (2014) Preoperative evaluation of venous anatomy in laparoscopic complete mesocolic excision for right colon cancer. Ann Surg Oncol 21:429–435

    Article  Google Scholar 

Download references

Acknowledgments

The authors deeply appreciate the contributions of all the surgeons, coworkers, and friends who participated in this study and thank the editors and reviewers for their help with this manuscript.

Disclosures

Authors Shinichiro Mori, Kenji Baba, Masayuki Yanagi, Yoshiaki Kita, Shigehiro Yanagita, Yasuto Uchikado, Takaaki Arigami, Yoshikazu Uenosono, Hiroshi Okumura, Akihiro Nakajo, Kosei Maemura, Sumiya Ishigami and Shoji Natsugoe have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan

    Shinichiro Mori, Kenji Baba, Masayuki Yanagi, Yoshiaki Kita, Shigehiro Yanagita, Yasuto Uchikado, Takaaki Arigami, Yoshikazu Uenosono, Hiroshi Okumura, Akihiro Nakajo, Kosei Maemuras, Sumiya Ishigami & Shoji Natsugoe

Authors
  1. Shinichiro Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenji Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masayuki Yanagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshiaki Kita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shigehiro Yanagita
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasuto Uchikado
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takaaki Arigami
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshikazu Uenosono
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroshi Okumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akihiro Nakajo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kosei Maemuras
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sumiya Ishigami
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Shoji Natsugoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinichiro Mori.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mori, S., Baba, K., Yanagi, M. et al. Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer. Surg Endosc 29, 34–40 (2015). https://doi.org/10.1007/s00464-014-3650-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3650-3

Keywords

Search

Navigation