To investigate the safety and feasibility of the completely medial access by page-turning approach (CMAP) for laparoscopic right hemi-colectomy.
In this retrospective study, the data from 72 patients who underwent laparoscopic right hemi-colectomy with CMAP were analyzed and compared with data from 124 patients who underwent the conventional medial approach performed by the same surgical team from September 2011 to March 2017.
Complete mesocolic excision (CME) was achieved in 67 of 72 patients (93.1%) with laparoscopic CMAP. The average operation time, blood loss, and specimen length was 135.9 ± 28.3 min, 63.2 ± 32.2 ml, and 23.9 ± 4.7 cm, respectively. The number of lymph nodes harvested was 20.6 ± 7.7, the time-to-flatus was 2.5 ± 0.8 days, the time-to-fluid intake was 3.2 ± 0.8 days, and the average hospital stay was 8.9 ± 4.7 days. No intra-operative complications occurred in this study. The vessel-related complication and total post-operative complication rate was 2.78% (2/72) and 6.94% (5/72), respectively.
Laparoscopic CMAP was an alternative approach for CME in laparoscopic right hemi-colectomy, which was proved safe and feasible for right colon cancer.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81(9):503–508
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(4):354–364. https://doi.org/10.1111/j.1463-1318.2008.01735.x discussion 364–355.
Kontovounisios C, Kinross J, Tan E, Brown G, Rasheed S, Tekkis P (2015) Complete mesocolic excision in colorectal cancer: a systematic review. Colorectal Dis 17(1):7–16. https://doi.org/10.1111/codi.12793
Mori S, Kita Y, Baba K, Yanagi M, Tanabe K, Uchikado Y, Kurahara H, Arigami T, Uenosono Y, Mataki Y, Okumura H, Nakajo A, Maemura K, Natsugoe S (2017) Laparoscopic complete mesocolic excision via combined medial and cranial approaches for transverse colon cancer. Surg Today 47(5):643–649. https://doi.org/10.1007/s00595-016-1409-2
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(2):272–278. https://doi.org/10.1200/JCO.2009.24.1448
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(15):1763–1769. https://doi.org/10.1200/JCO.2011.38.3992
Adamina M, Manwaring ML, Park KJ, Delaney CP (2012) Laparoscopic complete mesocolic excision for right colon cancer. Surg Endosc 26(10):2976–2980. https://doi.org/10.1007/s00464-012-2294-4
Storli KE, Sondenaa K, Furnes B, Eide GE (2013) Outcome after introduction of complete mesocolic excision for colon cancer is similar for open and laparoscopic surgical treatments. Digest Surg 30(4–6):317–327. https://doi.org/10.1159/000354580
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(12):3669–3675. https://doi.org/10.1007/s00464-012-2435-9
Benz S, Tam Y, Tannapfel A, Stricker I (2016) The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision. Surg Endosc 30(5):1930–1937. https://doi.org/10.1007/s00464-015-4417-1
Matsuda T, Iwasaki T, Mitsutsuji M, Hirata K, Maekawa Y, Tsugawa D, Sugita Y, Sumi Y, Shimada E, Kakeji Y (2015) Cranially approached radical lymph node dissection around the middle colic vessels in laparoscopic colon cancer surgery. Langenbeck Arch Surg 400(1):113–117. https://doi.org/10.1007/s00423-014-1250-2
Petz W, Ribero D, Bertani E, Borin S, Formisano G, Esposito S, Spinoglio G, Bianchi PP (2017) Suprapubic approach for robotic complete mesocolic excision in right colectomy: Oncologic safety and short-term outcomes of an original technique. Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2017.07.020
Subbiah R, Bansal S, Jain M, Ramakrishnan P, Palanisamy S, Palanivelu PR, Chinusamy P (2016) Initial retrocolic endoscopic tunnel approach (IRETA) for complete mesocolic excision (CME) with central vascular ligation (CVL) for right colonic cancers: technique and pathological radicality. Int J Colorectal Dis 31(2):227–233. https://doi.org/10.1007/s00384-015-2415-3
Zheng MH, Feng B, Lu AG, Li JW, Wang ML, Mao ZH, Hu YY, Dong F, Hu WG, Li DH, Zang L, Peng YF, Yu BM (2005) Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 11(3):323–326
West NP, Morris EJA, 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(9):857–865. https://doi.org/10.1016/S1470-2045(08)70181-5
Culligan K, Walsh S, Dunne C, Walsh M, Ryan S, Quondamatteo F, Dockery P, Coffey JC (2014) The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg 260(6):1048–1056. https://doi.org/10.1097/Sla.0000000000000323
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, Grp DCC (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16(2):161–168. https://doi.org/10.1016/S1470-2045(14)71168-4
Feng B, Ling TL, Lu AG, Wang ML, Ma JJ, Li JW, Zang L, Sun J, Zheng MH (2014) Completely medial versus hybrid medial approach for laparoscopic complete mesocolic excision in right hemicolon cancer. Surg Endosc 28(2):477–483. https://doi.org/10.1007/s00464-013-3225-8
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(1):89–97. https://doi.org/10.1007/s00384-013-1766-x
Zurleni T, Cassiano A, Gjoni E, Ballabio A, Serio G, Marzoli L, Zurleni F (2017) Surgical and oncological outcomes after complete mesocolic excision in right-sided colon cancer compared with conventional surgery: a retrospective, single-institution study. Int J Colorectal Dis. https://doi.org/10.1007/s00384-017-2917-2
Weitz J, Koch M, Debus J, Hohler T, Galle PR, Buchler MW (2005) Colorectal cancer. Lancet 365(9454):153–165. https://doi.org/10.1016/S0140-6736(05)17706-X
Mori S, Kita Y, Baba K, Yanagi M, Tanabe K, Uchikado Y, Kurahara H, Arigami T, Uenosono Y, Mataki Y, Nakajo A, Maemura K, Natsugoe S (2017) Laparoscopic complete mesocolic excision via mesofascial separation for left-sided colon cancer. Surg Today. https://doi.org/10.1007/s00595-017-1580-0
Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, Yin M, Yang X, Wang S, Ye Y (2017) Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Colorectal Dis 19(11):962–972. https://doi.org/10.1111/codi.13900
Miyazawa M, Kawai M, Hirono S, Okada K, Shimizu A, Kitahata Y, Yamaue H (2015) Preoperative evaluation of the confluent drainage veins to the gastrocolic trunk of Henle: understanding the surgical vascular anatomy during pancreaticoduodenectomy. J Hepato-Bil-Pan Sci 22(5):386–391. https://doi.org/10.1002/jhbp.205
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. https://doi.org/10.1245/s10434-014-3572-2
Nesgaard JM, Stimec BV, Bakka AO, Edwin B, Ignjatovic D, group RCCs (2015) Navigating the mesentery: a comparative pre- and per-operative visualization of the vascular anatomy. Colorectal Dis 17(9):810–818. https://doi.org/10.1111/codi.13003
Feng B, Yan X, Zhang S, Xue P, He Z, Zheng M (2017) [Anatomical strategies of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 20(6):635–638
Pigazzi A, Hellan M, Ewing DR, Paz BI, Ballantyne GH (2007) Laparoscopic medial-to-lateral colon dissection: how and why. J Gastrointest Surg 11(6):778–782. https://doi.org/10.1007/s11605-007-0120-4
Ziri He, Sen Zhang, Pei Xue, Xialin Yan, Leqi Zhou, Jianwen Li, Mingliang Wang, Aiguo Lu, Junjun Ma, Lu Zang, Hiju Hong, Feng Dong, Hao Su, Jing Sun, Luyang Zhang, Minhua Zheng, and Bo Feng have no conflicts of interest or financial ties to disclose.
About this article
Cite this article
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 33, 959–965 (2019) doi:10.1007/s00464-018-6525-1
- Complete mesocolic excision
- Laparoscopic right hemi-colectomy
- Anatomic variation
- Medial access
- Page-turning approach