Advertisement

Surgical Endoscopy

, Volume 26, Issue 10, pp 2976–2980 | Cite as

Laparoscopic complete mesocolic excision for right colon cancer

  • Michel Adamina
  • Mark L. Manwaring
  • Ki-Jae Park
  • Conor P. Delaney
Video

Abstract

Laparoscopic colectomy for colon cancer has become a standard of care, with a number of publications highlighting its safety, improved postoperative recovery, and excellent oncologic outcomes. Complete mesocolic excision, recently reemphasized, is associated with superior oncologic outcomes, although this has not been discussed for laparoscopic surgery. A laparoscopic approach was performed for right colon cancer using a four-trocar technique. The key steps demonstrated are identification and high division of the ileocolic pedicle, medial-to-lateral mobilization of the ascending colon preserving the posterior mesocolic fascia, identification and high division of the right branch of the middle colic artery, mobilization of the greater omentum and hepatic flexure, completion of lateral mobilization of the ascending colon from the retroperitoneum, and mobilization of the small bowel mesentery up to the duodenum. A prospective series of 52 consecutive patients with right colon cancer underwent laparoscopic complete mesocolic excision with high-vessel ligation. Four of the patients required laparoscopic en bloc extended resections for local invasion. The median operative time was 136 min (interquartile range [IQR], 105–167 min), and the median blood loss was 20 ml (IQR, 10–45 ml). The median hospital stay was 3 days (IQR, 3–5 days). All the patients had an R0 oncologic resection with median margins of 12 cm, and a median of 22 lymph nodes (IQR, 18–29 lymph nodes) was retrieved. The median follow-up period was 38 months (IQR, 23–54 months). Of 14 patients with tumor-positive lymph nodes, 2 experienced distant recurrence. There were no local recurrences, but four patients experienced metastatic disease at a median of 37 months (IQR, 22–46 months). The median overall survival time was 38 months (IQR, 23–54 months). The embedded didactic video demonstrates a straight laparoscopic complete mesocolic excision with high-vessel ligation for a patient who had a right colon cancer. Laparoscopic right complete mesocolic excision is a safe and effective procedure associated with excellent 3-year oncologic outcomes and accelerated postoperative recovery.

Keywords

Colon cancer Complete mesocolic excision Laparoscopy 

Notes

Disclosures

Michel Adamina, Mark L. Manwaring, Ki-Jae Park, and Conor P. Delaney have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 113446 kb)

References

  1. 1.
    Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645PubMedCrossRefGoogle Scholar
  2. 2.
    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 248:1–7PubMedCrossRefGoogle Scholar
  3. 3.
    Liang JT, Huang KC, Lai HS, Lee PH, Jeng YM (2007) Oncologic results of laparoscopic versus conventional open surgery for stage II or III left-sided colon cancers: a randomized controlled trial. Ann Surg Oncol 14:109–117PubMedCrossRefGoogle Scholar
  4. 4.
    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 246:655–662PubMedCrossRefGoogle Scholar
  5. 5.
    Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52PubMedCrossRefGoogle Scholar
  6. 6.
    Braga M, Frasson M, Zuliani W, Vignali A, Pecorelli N, Di Carlo V (2010) Randomized clinical trial of laparoscopic versus open left colonic resection. Br J Surg 97:1180–1186PubMedCrossRefGoogle Scholar
  7. 7.
    Steele SR, Brown TA, Rush RM, Martin MJ (2008) Laparoscopic vs open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg 12:583–591PubMedCrossRefGoogle Scholar
  8. 8.
    Janson M, Edlund G, Kressner U, Lindholm E, Pahlman L, Skullman S, Anderberg B, Haglind E (2009) Analysis of patient selection and external validity in the Swedish contribution to the COLOR trial. Surg Endosc 23:1764–1769PubMedCrossRefGoogle Scholar
  9. 9.
    Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824PubMedCrossRefGoogle Scholar
  10. 10.
    Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2: CD003432Google Scholar
  11. 11.
    Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840PubMedCrossRefGoogle Scholar
  12. 12.
    Fullum TM, Ladapo JA, Borah BJ, Gunnarsson CL (2010) Comparison of the clinical and economic outcomes between open and minimally invasive appendectomy and colectomy: evidence from a large commercial payer database. Surg Endosc 24:845–853PubMedCrossRefGoogle Scholar
  13. 13.
    Stucky CC, Pockaj BA, Novotny PJ, Sloan JA, Sargent DJ, O’Connell MJ, Beart RW, Skibber JM, Nelson H, Weeks JC (2011) Long-term follow-up and individual item analysis of quality-of-life assessments related to laparoscopic-assisted colectomy in the COST trial 93-46-53 (INT 0146). Ann Surg Oncol 18:2422–2431PubMedCrossRefGoogle Scholar
  14. 14.
    Janson M, Lindholm E, Anderberg B, Haglind E (2007) Randomized trial of health-related quality of life after open and laparoscopic surgery for colon cancer. Surg Endosc 21:747–753PubMedCrossRefGoogle Scholar
  15. 15.
    Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388PubMedCrossRefGoogle Scholar
  16. 16.
    Janson M, Bjorholt I, Carlsson P, Haglind E, Henriksson M, Lindholm E, Anderberg B (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91:409–417PubMedCrossRefGoogle Scholar
  17. 17.
    Braga M, Vignali A, Zuliani W, Frasson M, Di Serio C, Di Carlo V (2005) Laparoscopic versus open colorectal surgery: cost-benefit analysis in a single-center randomized trial. Ann Surg 242:890–895PubMedCrossRefGoogle Scholar
  18. 18.
    Koopmann MC, Harms BA, Heise CP (2007) Money well spent: a comparison of hospital operating margin for laparoscopic and open colectomies. Surgery 142:546–553PubMedCrossRefGoogle Scholar
  19. 19.
    Senagore AJ, Brannigan A, Kiran RP, Brady K, Delaney CP (2005) Diagnosis-related group assignment in laparoscopic and open colectomy: financial implications for payer and provider. Dis Colon Rectum 48:1016–1020PubMedCrossRefGoogle Scholar
  20. 20.
    Senagore AJ, Delaney CP, Brady KM, Fazio VW (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg 199:675–679PubMedCrossRefGoogle Scholar
  21. 21.
    Delaney CP, Neary PC, Heriot AG, Senagore AJ (2007) Operative techniques in laparoscopic colorectal, 1st edn. Lippincott Williams and Wilkins, PhilapelphiaGoogle Scholar
  22. 22.
    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 11:354–364PubMedCrossRefGoogle Scholar
  23. 23.
    Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, MacDonald JS, Catalano PJ, Haller DG (2003) Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol 21:2912–2919PubMedCrossRefGoogle Scholar
  24. 24.
    Liang JT, Huang KC, Lai HS, Lee PH, Sun CT (2007) Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol 14:1980–1990PubMedCrossRefGoogle Scholar
  25. 25.
    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 9:857–865PubMedCrossRefGoogle Scholar
  26. 26.
    Jagoditsch M, Lisborg PH, Jatzko GR, Wette V, Kropfitsch G, Denk H, Klimpfinger M, Stettner HM (2000) Long-term prognosis for colon cancer related to consistent radical surgery: multivariate analysis of clinical, surgical, and pathologic variables. World J Surg 24:1264–1270PubMedCrossRefGoogle Scholar
  27. 27.
    Bokey EL, Chapuis PH, Dent OF, Mander BJ, Bissett IP, Newland RC (2003) Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon Rectum 46:860–866PubMedCrossRefGoogle Scholar
  28. 28.
    Delaney CP (2008) Outcome of discharge within 24 to 72 hours after laparoscopic colorectal surgery. Dis Colon Rectum 51:181–185PubMedCrossRefGoogle Scholar
  29. 29.
    Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines for laparoscopic resection of curable colon and rectal cancer. Available at http://www.sages.org/publication/id/32/. Accessed 16 Sept 2011
  30. 30.
    Adamina M, Champagne BJ, Hoffman L, Ermlich MB, Delaney CP (2011) Randomized clinical trial comparing the cost and effectiveness of bipolar vessel sealers versus clips and vascular staplers for laparoscopic colorectal resection. Br J Surg 98:1703–1712PubMedCrossRefGoogle Scholar
  31. 31.
    Delaney CP, Brady K, Woconish D, Parmar SP, Champagne BJ (2012) Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways. Am J Surg 203:353–356PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Michel Adamina
    • 1
    • 2
  • Mark L. Manwaring
    • 3
  • Ki-Jae Park
    • 1
  • Conor P. Delaney
    • 1
  1. 1.Division of Colorectal SurgeryUniversity Hospitals Case Medical CenterClevelandUSA
  2. 2.Department of SurgeryKantonsspital St. GallenSt. GallenSwitzerland
  3. 3.Department of SurgeryEast Carolina UniversityGreenvilleUSA

Personalised recommendations