Abstract
Background
D3 lymphadenectomy is important for accurate staging and provides long-term benefits, especially for T3–4/N + tumors.1,2 Both D3 lymphadenectomy as well as complete mesocolic excision (CME) require central ligation of vessels at their origins to ensure radical resection.3 Currently, superior mesentery vein (SMV) is navigated by ileocolic vessels while its sheath is dissected stepwise from caudal to cranial.4,5,6 This report describes a new medial-to-lateral approach for laparoscopic right hemicolectomy with D3 + CME.
Methods
The patient was a 47-year-old man with diagnosis of hepatic flexure cancer (cT4N1M0). First, the pedicle of the middle colic vessels and ileocolic vessels were both grasped, then the sheath of SMV was dissected at its left side as there are fewer blood vessels entering here compared with its right side. Second, after identification of middle colic artery (MCA), SMV was skeletonized from medial to lateral and no. 213 and no. 203 lymph nodes were dissected. Third, MCA and ileocolic vein and artery (ICV and ICA) were ligated at their roots. After separating the transverse mesocolon from the duodenum, the branches of the Henle trunk were exposed and no. 223 lymph nodes were dissected. Accessory right colic vein, right colic vein, and middle colic vein were ligated respectively. Fourth, the ascending mesocolon was separated from the retroperitoneal tissues through the front side of Toldt’s fascia, the mesocolon was mobilized completely, and the tumor was removed en bloc.
Results
The operation time was 175 min, with estimated blood loss of 50 ml. The patient recovered well without bleeding complications and was discharged on postoperative day 7. Histology revealed moderately differentiated adenocarcinoma with 5 of 24 lymph nodes involved (pT3N2M0).
Conclusions
The medial-to-lateral approach presented in the video might be helpful for standardization of laparoscopic D3 + CME for right-sided colon cancer.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Okuno K. Surgical treatment for digestive cancer. Current issues—colon cancer. Dig Surg. 2007;24:108–14.
Han DP, Lu AG, Feng H, et al. Long-term results of laparoscopy-assisted radical right hemicolectomy with D3 lymphadenectomy: clinical analysis with 177 cases. Int J Colorectal Dis. 2013;28:623–9.
Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation–technical notes and outcome. Color Dis Off J Assoc Coloproctol GB Irel. 2009;11(4):354–64.
Du S, Zhang B, Liu Y, et al. A novel and safe approach: middle cranial approach for laparoscopic right hemicolon cancer surgery with complete mesocolic excision. Surg Endosc. 2018;32(5):2567–74.
He Z, Zhang S, Xue P, et al. Completely medial access by page-turning approach for laparoscopic right hemi-colectomy: 6-year-experience in single center. Surg Endosc. 2019;33(3):959–65.
Deng X, Hu T, Wei M, et al. Feasibility of a unidirectionally progressive, pancreas-oriented procedure for laparoscopic D3 right hemicolectomy. Langenbecks Arch Surg. 2018;403(6):761–8.
Acknowledgments
This study was funded by a scientific research project of Suining Central Hospital (Grant No. 2019y53).
Author information
Authors and Affiliations
Contributions
W.L., T.L. and Y.X. wrote the study; F.L., Z.X. and Y.J. selected and edited the video. W.L. approved the final version for publication.
Corresponding author
Ethics declarations
Disclosure
There are no conflicts of interest.
Informed Consent
Consent was obtained from the patient for publication of this report and any accompanying images.
Ethical Approval
This study was approved by the Ethics Committee of Suining Central Hospital.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MP4 115860 kb)
Rights and permissions
About this article
Cite this article
Luo, W., Lu, T., Xiao, Y. et al. A New Medial-to-Lateral Approach for Laparoscopic D3 Lymphadenectomy plus Complete Mesocolic Excision (D3 + CME) for Right-Sided Colon Cancer. Ann Surg Oncol 28, 3256–3257 (2021). https://doi.org/10.1245/s10434-020-09264-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-020-09264-1