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Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach: anatomical and embryological consideration

International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Complete mesocolic excision (CME) with central vascular ligation (CVL) should be employed for the treatment of colon cancer patients because of its superior oncological outcomes. However, this technique is technically challenging in laparoscopic right hemicolectomy because of the anatomical complexity of the transverse mesocolon.

Methods

We focused on the embryology and anatomy of the transverse mesocolon to overcome the difficulty of this surgery. The validity and efficacy of a cranial approach in achieving CME with CVL in laparoscopic right hemicolectomy was elucidated from the embryological point of view.

Results

In total, 28 consecutive patients with right-sided colon cancer were treated by laparoscopic right hemicolectomy using a cranial approach. There were no conversion to open surgery or switching to another approach. Using this approach, torsion and fusion of the transverse mesocolon, which occurred during embryological development, could be reversed and the complex anatomy of the transverse mesocolon could be simplified before performing CVL of colonic vessels.

Conclusions

A cranial approach is considered valid and useful for CME with CVL in laparoscopic right hemicolectomy from the embryological point of view.

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References

  1. Kapiteijn E, Putter H, van de Velde CJ (2002) Impact of the introduction and training of total mesorectal excision on recurrence and survival in rectal cancer in the Netherlands. Br J Surg 89(9):1142–1149

    Article  CAS  PubMed  Google Scholar 

  2. Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B (2000) Effect of a surgical training programme on outcome of rectal cancer in the county of Stockholm. Stockholm Colorectal Cancer Study Group. Basingstoke Bowel Cancer Res Proj Lancet 356(9224):93–96

    CAS  Google Scholar 

  3. 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. Color Dis 11(4):354–364 discussion 364-355

    Article  CAS  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Matsuda T, Iwasaki T, Mitsutsuji M, Hirata K, Maekawa Y, Tanaka T, Shimada E, Kakeji Y (2015) Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy. Surg Endosc 29(4):1001

    Article  PubMed  Google Scholar 

  6. 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. Langenbecks Arch Surg 400(1):113–117

    Article  PubMed  Google Scholar 

  7. Sadler TW (2012) Langman’s medical embryology, 12th edn. Lippincott, Philadelphia

    Google Scholar 

  8. Standring S (2015) Gray’s anatomy—the anatomical basis of clinical practice, 41st edn. Elsevier, Amsterdam

    Google Scholar 

  9. Acar HI, Comert A, Avsar A, Celik S, Kuzu MA (2014) Dynamic article: surgical anatomical planes for complete mesocolic excision and applied vascular anatomy of the right colon. Dis Colon Rectum 57(10):1169–1175

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Shinohara H, Kurahashi Y, Kanaya S, Haruta S, Ueno M, Udagawa H, Sakai Y (2013) Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery. Gastric Cancer 16(4):615–620

    Article  CAS  PubMed  Google Scholar 

  12. Hasegawa S, Kawamura J, Nagayama S, Nomura A, Kondo K, Sakai Y (2007) Medially approached radical lymph node dissection along the surgical trunk for advanced right-sided colon cancers. Surg Endosc 21(9):1657

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan

    Takeru Matsuda, Kimihiro Yamashita, Hiroshi Hasegawa, Masashi Yamamoto, Yoshiko Matsuda, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki & Yoshihiro Kakeji

  2. Department of Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan

    Takeshi Iwasaki

  3. Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Yasuo Sumi

Authors
  1. Takeru Matsuda
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  2. Takeshi Iwasaki
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  3. Yasuo Sumi
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  4. Kimihiro Yamashita
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  5. Hiroshi Hasegawa
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  6. Masashi Yamamoto
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  7. Yoshiko Matsuda
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  8. Shingo Kanaji
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  9. Taro Oshikiri
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  10. Tetsu Nakamura
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  11. Satoshi Suzuki
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  12. Yoshihiro Kakeji
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Corresponding author

Correspondence to Takeru Matsuda.

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The authors declare that they have no conflict of interest.

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Matsuda, T., Iwasaki, T., Sumi, Y. et al. Laparoscopic complete mesocolic excision for right-sided colon cancer using a cranial approach: anatomical and embryological consideration. Int J Colorectal Dis 32, 139–141 (2017). https://doi.org/10.1007/s00384-016-2673-8

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  • DOI: https://doi.org/10.1007/s00384-016-2673-8

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