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Hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation: a novel technique for right colon cancer

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Abstract

Background

It can be difficult to locate the superior mesenteric vein and dissect around middle colic vessels during laparoscopic right hemicolectomy with complete mesocolon excision due to a high rate of vascular variations in the superior mesenteric vessels. Therefore, we report a modified technique for hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation, which addresses these two problems.

Methods

Thirty-one consecutive patients with right colon cancer underwent this procedure from March 2014 to August 2015. Extracorporeally, the transverse colon and distal ileum were excised with a transumbilical hand-port incision, and the distal part of the superior mesenteric vein was identified. Intracorporeally, with the assistance of the surgeon’s left hand inserted through the incision, D3-lymphadenectomy with central vascular ligation was performed, and the colon with the tumor, which had no blood supply, was removed. Patients’ demographic data and intraoperative, postoperative and pathological characteristics were examined.

Results

The median operative time was 130.0 (range 115–180) minutes. The median blood loss was 45.0 (range 20–300) milliliters. The median length of the hand-port incision was 7.3 (range 6.0–8.2) centimeters. The median numbers of lymph nodes and central lymph nodes was 34.0 (range 18–91) and 13.0 (range 3–28), respectively. Five (16.1%) of 31 patients had positive central lymph nodes. Specimen morphometric quantitation was as follows: the median distances from the tumor and nearest bowel wall to the high tie were 10.5 (range 5.0–15.0) and 8.0 (range 6.0–12.0) centimeters, respectively; the median resected area of the mesentery was 200.0 (range 96.0–300.0) square centimeters; the median width of the chain of lymph-adipose tissue at the central lymph nodes area was 2.0 (range 0.8–8.0) centimeters; and the median length of the central lymph-adipose chain was 19.0 (range 3.0–26.0) centimeters.

Conclusions

Our procedure confers technical advantages and is feasible for treatment of right colon cancer.

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References

  1. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150

    CAS  PubMed  Google Scholar 

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

    Article  Google Scholar 

  3. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  Google Scholar 

  4. 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 

  5. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662 (discussion 662–654)

    Article  Google Scholar 

  6. Jin K, Wang J, Lan H, Zhang R (2014) Laparoscopic surgery for colorectal cancer in China: an overview. Int J Clin Exp Med 7:4635–4645

    PubMed  PubMed Central  Google Scholar 

  7. Romanelli JR, Kelly JJ, Litwin DE (2001) Hand-assisted laparoscopic surgery in the United States: an overview. Sem Laparosc Surg 8:96–103

    Article  CAS  Google Scholar 

  8. Bae SU, Park JS, Choi YJ, Lee MK, Cho BS, Kang YJ, Park JS, Kim CN (2014) The role of hand-assisted laparoscopic surgery in a right hemicolectomy for right-sided colon cancer. Ann Coloproctol 30:11–17

    Article  Google Scholar 

  9. Yang I, Boushey RP, Marcello PW (2013) Hand-assisted laparoscopic colorectal surgery. Tech Coloproctol 17(Suppl 1):S23–S27

    Article  Google Scholar 

  10. Targarona EM, Gracia E, Garriga J, Martinez-Bru C, Cortes M, Boluda R, Lerma L, Trias M (2002) Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy: applicability, immediate clinical outcome, inflammatory response, and cost. Surg Endosc 16:234–239

    Article  CAS  Google Scholar 

  11. Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL (2008) Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 51:818–826 (discussion 826–818)

    Article  Google Scholar 

  12. 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 (discussion 364–355)

    Article  CAS  Google Scholar 

  13. 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  Google Scholar 

  14. 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  Google Scholar 

  15. Kang J, Kim IK, Kang SI, Sohn SK, Lee KY (2014) Laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc 28:2747–2751

    Article  Google Scholar 

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

    Article  Google Scholar 

  17. 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  Google Scholar 

  18. Zhao LY, Liu H, Wang YN, Deng HJ, Xue Q, Li GX (2014) Techniques and feasibility of laparoscopic extended right hemicolectomy with D3 lymphadenectomy. World J Gastroenterol 20:10531–10536

    Article  Google Scholar 

  19. Han DP, Lu AG, Feng H, Wang PX, Cao QF, Zong YP, Feng B, Zheng MH (2014) Long-term outcome of laparoscopic-assisted right-hemicolectomy with D3 lymphadenectomy versus open surgery for colon carcinoma. Surg Today 44:868–874

    Article  Google Scholar 

  20. Kanemitsu Y, Komori K, Kimura K, Kato T (2013) D3 lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum 56:815–824

    Article  Google Scholar 

  21. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260:23–30

    Article  Google Scholar 

  22. 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  Google Scholar 

  23. Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gogenur I (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16:161–168

    Article  Google Scholar 

  24. 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 29:89–97

    Article  Google Scholar 

  25. Melich G, Jeong DH, Hur H, Baik SH, Faria J, Kim NK, Min BS (2014) Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy—analysis of learning curves for a novice minimally invasive surgeon. Can J Surg 57:331–336

    Article  Google Scholar 

  26. 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(Suppl 3):S429–S435

    Article  Google Scholar 

  27. Mori S, Baba K, Yanagi M, Kita Y, Yanagita S, Uchikado Y, Arigami T, Uenosono Y, Okumura H, Nakajo A, Maemuras K, Ishigami S, Natsugoe S (2014) Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk for right colon cancer. Surg Endosc 29(1):34–40

    Article  Google Scholar 

  28. Kang JC, Chung MH, Chao PC, Yeh CC, Hsiao CW, Lee TY, Jao SW (2004) Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study. Surg Endosc 18:577–581

    Article  Google Scholar 

  29. Siani LM, Pulica C (2014) Laparoscopic complete mesocolic excision with central vascular ligation in right colon cancer: long-term oncologic outcome between mesocolic and non-mesocolic planes of surgery. Scand J Surg 104(4):219–226

    Article  Google Scholar 

  30. Atkin G, Chopada A, Mitchell I (2005) Colorectal cancer metastasis: in the surgeon’s hands? Int Sem Surg Oncol 2:5

    Article  Google Scholar 

  31. Wiggers T, Jeekel J, Arends JW, Brinkhorst AP, Kluck HM, Luyk CI, Munting JD, Povel JA, Rutten AP, Volovics A et al (1988) No-touch isolation technique in colon cancer: a controlled prospective trial. Br J Surg 75:409–415

    Article  CAS  Google Scholar 

  32. Han DP, Lu AG, Feng H, Wang PX, Cao QF, Zong YP, Feng B, Zheng MH (2013) Long-term results of laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy: clinical analysis with 177 cases. Int J Colorectal Dis 28:623–629

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by the Science and Technology Support Program of the Science & Technology Department of Sichuan Province (Grant Number: 2016SZ0043) and the National Natural Science Foundation of China (Grant Number: 81172373). We acknowledge Rang Gao (West China School of Medicine, Sichuan University), who helped prepare the figures. We also acknowledge Yan Yan (School of Life Sciences, Chinese University of Hong Kong), who helped prepare the video.

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    Authors and Affiliations

    1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang No. 37, Chengdu, 610041, China

      Qing-Bin Wu, Xiang-Bing Deng, Xu-Yang Yang, Wan-Bin He, Tao Hu, Ming-Tian Wei & Zi-Qiang Wang

    2. West China School of Medicine, Sichuan University, Chengdu, 610041, China

      Qing-Bin Wu, Wan-Bin He & Tao Hu

    3. The Surgical Department of Coloproctology, Zhejiang Provincial People’s Hospital, Hangzhou, 310014, Zhejiang, China

      Bing-Chen Chen

    4. State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China

      Ming-Tian Wei

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    Drs. Qingbin Wu, Xiangbing Deng, Xuyang Yang, Bingchen Chen, Wanbin He, Tao Hu, Mingtian Wei, and Ziqiang Wang have no conflicts of interest or financial ties to disclose.

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    Qing-Bin Wu, Xiang-Bing Deng and Xu-Yang Yang have contributed equally to this work.

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    Wu, QB., Deng, XB., Yang, XY. et al. Hand-assisted laparoscopic right hemicolectomy with complete mesocolic excision and central vascular ligation: a novel technique for right colon cancer. Surg Endosc 31, 3383–3390 (2017). https://doi.org/10.1007/s00464-016-5354-3

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