title: Techniques and feasibility of laparoscopic extended right hemicolectomy with D3 lymphadenectomy.
abstract: OBJECTIVE
  To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy (LERH), according to our previous experience.
  
  
  METHODS
  Anatomical relationship and operative techniques were demonstrated. One hundred and five consecutive patients who underwent extended right hemicolectomy with D3 lymphadenectomy between January 2008 and May 2011 were included in the present study [laparoscopic group (n = 48) vs open group (n = 57)].
  
  
  RESULTS
  The right retrocolic space was the main surgical plan of the LERH. The superior mesenteric vein was the most important anatomical landmark for vascular dissection. The medial-to-lateral dissection approach made the LERH performed efficiently. Compared with the open group, the LERH group had less blood loss (111.7 ± 127.8 mL vs 170.2 ± 49.7 mL, P = 0.023), faster return of flatus (3.0 ± 1.6 d vs 3.7 ± 1.3 d, P = 0.019), and earlier diet (4.2 ± 1.4 d vs 5.0 ± 1.2 d, P = 0.005). Five patients (10.4%) underwent conversion during laparoscopic surgery. The cancer recurrence rates between the two groups were comparable (laparoscopic vs open, 8.6% vs 9.1%, P = 0.335).
  
  
  CONCLUSIONS
  For an advanced tumor located at the hepatic flexure or proximal transverse colon, LERH with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space severed as the surgical plan.
authors.affiliation: Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Zhao
authors.affiliation: Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Ya-Nan
authors.initials: YN
authors.lastname: Wang
authors.affiliation: Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Hai-Jun
authors.initials: HJ
authors.lastname: Deng
authors.affiliation: Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Xue
authors.affiliation: Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
authors.forename: Guo-Xin
authors.initials: GX
authors.lastname: Li
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anatomy; Colon cancer; D3 lymphadenectomy; Hepatic flexure; Laparoscopic colectomy