title: Laparoscopic complete mesocolic excision for right colon cancer.
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.
authors.affiliation: Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA. michel.adamina@gmail.com
authors.forename: Michel
authors.initials: M
authors.lastname: Adamina
authors.forename: Mark L
authors.initials: ML
authors.lastname: Manwaring
authors.forename: Ki-Jae
authors.initials: KJ
authors.lastname: Park
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008207:Lymphatic Metastasis; D008297:Male; D008646:Mesocolon / Q000601:surgery*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D061646:Operative Time; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome