Advertisement

Surgical Endoscopy

, Volume 25, Issue 5, pp 1659–1660 | Cite as

Radical lymphadenectomy for advanced colon cancer via separation of the mesocolon into two layers as in filleting fish

  • Dai Uematsu
  • Gaku Akiyama
  • Akiko Magishi
Multimedia Manuscript

Abstract

Background

Radical lymphadenectomy for advanced colon cancer performed via the medial approach improves oncologic outcomes. However, D3 radical lymphadenectomy possesses some unresolved problems such as the complicated vascular anatomy and concerns over surgical morbidity [1, 2, 3, 4, 5]. The authors present a simple and safe procedure for laparoscopic right or left hemicolectomy using a medial approach to overcome these problems. The key characteristic of their procedure is separation of the mesocolon into two layers along the superior or inferior mesenteric artery, showing the course of these branches under the mantle of the vascular sheath. This procedure resembles filleting fish into two pieces.

Methods

Between October 2009 and March 2010, 11 consecutive patients with advanced colon cancer underwent a curative laparoscopic right (n = 5) or left (n = 6) hemicolectomy via a medial approach by a single surgeon. The body mass image (BMI) for the 11 patients ranged from 22 to 32 kg/m2. With this procedure, the D3 lymphadenectomy procedure is performed first [6]. The mesocolon is dissected between the superficial layer of the fat tissue and the deep layer of the vascular sheath along the superior or inferior mesenteric artery. After the course of each branch is exposed, each supplying or draining vessel is transected at its root [7, 8]. The use of a laparoscope and a spatula-type electric cautery greatly contributes to this procedure [9]. Next, the bowel is mobilized, and the specimen is retrieved through the small incision. Finally, extra- or intracorporeal anastomosis is performed.

Results

No intraoperative complications occurred. The median number of retrieved lymph nodes was 23 (range, 13–52). The median total operative time was 220 min (range, 145–318 min), and the intraoperative blood loss was minimal (range, 0–70 g). The postoperative course was uneventful for all the patients.

Conclusions

The authors consider the described method to be simple and safe for radical lymphadenectomy during a laparoscopic right or left hemicolectomy.

Keywords

Colectomy Colon cancer Laparoscopy Lymph node dissection Lymphadenectomy 

Notes

Disclosures

Dai Uematsu, Gaku Akiyama, and Akiko Magishi have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 92118 kb)

References

  1. 1.
    Lee SD, Lim S-B (2009) D3 lymphadenectomy using a medial to lateral approach for curable right-sided colon cancer. Int Colorectal Dis 24:295–300CrossRefGoogle Scholar
  2. 2.
    Hohenberger W, Weber K, Matzel K (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation: technical notes and outcome. Colorectal Dis 11:354–365PubMedCrossRefGoogle Scholar
  3. 3.
    Toyota S, Ohta H, Anazawa S (1995) Rationale for extent of lymph node dissection for right colon cancer. Dis Colon Rectum 38:705–711PubMedCrossRefGoogle Scholar
  4. 4.
    Baca Z, Perko I, Bokan Z (2005) Technique and survival after laparoscopically assisted right hemicolectomy. Surg Endoc 19:650–655CrossRefGoogle Scholar
  5. 5.
    Jensen TC, Poon W-L, Law JK, Fan M (2009) Impact of the standardized medial-to-lateral approach on outcome of laparoscopic colorectal resection. World J Surg 33:2177–2182CrossRefGoogle Scholar
  6. 6.
    Japanese Society for Cancer of the Colon and Rectum (1997) Japanese classification of colorectal carcinoma. Kanehara, TokyoGoogle Scholar
  7. 7.
    Yamaguchi S, Kuroyanagi H, Shimada H (2002) Venous anatomy of the right colon. Dis Colon Rectum 45:1337–1340PubMedCrossRefGoogle Scholar
  8. 8.
    Shatati T, Fujita M, Nozawa K (2003) Vascular anatomy for right colon lymphadenectomy. Surg Radiol Anat 25:86–88CrossRefGoogle Scholar
  9. 9.
    Hasegawa S, Kawamura J, Sakai Y (2007) Medially approach radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers. Surg Endosc 21:1657PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Digestive SurgerySaku Central HospitalSaku-City, NaganoJapan

Personalised recommendations