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Intracorporeal Vessel Ligation in Laparoscopic Right Colectomy for Cancer is Associated with Increased Lymph Node Yield

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Abstract

Background

This study aimed to compare intra- and extracorporeal division of the vascular pedicle in laparoscopic right colectomy regarding pathological outcomes, short-term morbidity, and local recurrence and distant metastases.

Methods

Retrospective analysis of an IRB-approved database of all patients who underwent laparoscopic right colectomy for cancer between 01/2011 and 08/2021. Main outcome measures were number of harvested lymph nodes, length of resected colon, R1 rate, positive lymph node ratio, short-term post-operative morbidity, local recurrence, and distant metastases.

Results

Two-hundred seventy-one consecutive patients (136 males) patients underwent laparoscopic right hemicolectomy for cancer during the study period. Vessel ligation was intracorporeal in 171 (63%) and extracorporeal in 100 patients (37%); groups had similar baseline characteristics except for extent of resection as extended right hemicolectomy was significantly more often performed in the intracorporeal group. When the two groups were matched for the extent of resection (standard versus extended right hemicolectomy), the mean number of harvested lymph nodes (28.61 ± 12.04 versus 25.37 ± 10.06, p = 0.04) and median length of the resected colon [26.00 (IQR: 21.00, 32.00) versus 23.00 (IQR: 19.00, 27.00) cm, p = 0.003] were significantly higher in the intracorporeal than in the extracorporeal group. The intracorporeal group required a significantly longer operative time than did the extracorporeal group (168.94 ± 57.9 vs. 139.7 ± 41.3 mins, p = 0.001). No significant differences were noted between the groups in terms of ileus, hemorrhage, surgical site infection, re-operation rates, recurrence, or distant metastases.

Conclusion

Intracorporeal vessel ligation in laparoscopic right hemicolectomy was associated with increased lymph node yield and longer specimens, although requiring longer operative times. Postoperative clinical outcomes were similar to outcomes in the extracorporeal ligation group.

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Authors and Affiliations

  1. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Zoe Garoufalia, Sameh Hany Emile, Rachel Gefen, Kaylee Watson, Jared Emolo, Nir Horesh, Giovanna DaSilva, Eric G. Weiss & Steven D. Wexner

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

    Sameh Hany Emile

  3. Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel

    Rachel Gefen

  4. Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel

    Nir Horesh

Authors
  1. Zoe Garoufalia
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  2. Sameh Hany Emile
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  3. Rachel Gefen
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  4. Kaylee Watson
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  5. Jared Emolo
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  6. Nir Horesh
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  7. Giovanna DaSilva
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  8. Eric G. Weiss
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  9. Steven D. Wexner
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Corresponding author

Correspondence to Steven D. Wexner.

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Conflict of interest

No relevant financial disclosures. Dr. Wexner reports receiving consulting fees from ARC/Corvus, Astellas, Baxter, Becton Dickinson, GI Supply, ICON Language Services, Intuitive Surgical, Leading BioSciences, Livsmed, Medtronic, Olympus Surgical, Stryker, Takeda and receiving royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc, Medtronic, Unique Surgical Innovations, LLC. Dr. Emile receives consulting fees from SafeHeal.

Ethical approval

This study was approved by the Institutional Review Board of our institution.

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Garoufalia, Z., Emile, S.H., Gefen, R. et al. Intracorporeal Vessel Ligation in Laparoscopic Right Colectomy for Cancer is Associated with Increased Lymph Node Yield. World J Surg 47, 3356–3362 (2023). https://doi.org/10.1007/s00268-023-07181-4

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  • DOI: https://doi.org/10.1007/s00268-023-07181-4

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