title: Cranially approached radical lymph node dissection around the middle colic vessels in laparoscopic colon cancer surgery.
abstract: OBJECTIVE
  Laparoscopic lymph node (LN) dissection around the middle colic vessels is technically demanding, thus raising controversy regarding the role of laparoscopic surgery for transverse colon cancer. We herein describe a cranial approach method to perform radical LN dissection around the middle colic vessels. The key characteristic of this approach is early division of middle colic vessels prior to mobilization of the colon.
  
  
  METHODS
  From April 2010 to September 2013, 27 patients with colon cancer received laparoscopic LN dissection around the middle colic vessels using this cranial approach. Their surgical and short-term outcomes were reviewed.
  
  
  RESULTS
  The mean number of harvested LNs was 29 (range, 6-50). The mean operative time and intraoperative blood loss were 274 min (range, 160-362 min) and 42 mL (range, 3-247 mL), respectively. There were no serious intraoperative complications or conversions to open surgery. There were two patients with stage 0, 7 with stage I, 12 with stage II, and 6 with stage III. No recurrent case was observed with a median follow-up period of 30 months (range, 9-48 months).
  
  
  CONCLUSIONS
  We consider this approach feasible and useful for radical LN dissection around the middle colic vessels during laparoscopic colon cancer surgery.
authors.affiliation: Department of Surgery, National Hospital Organization Kobe Medical Center, 3-1-1 Nishi-Ochiai, Suma-ku, Kobe, 654-0155, Japan, takerumatsuda@nifty.com.
authors.forename: Takeru
authors.initials: T
authors.lastname: Matsuda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Mitsutsuji
authors.forename: Kenro
authors.initials: K
authors.lastname: Hirata
authors.forename: Yoko
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsugawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sumi
authors.forename: Etsuji
authors.initials: E
authors.lastname: Shimada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D016063:Blood Loss, Surgical; D003106:Colon / Q000098:blood supply*; D003110:Colonic Neoplasms / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D061646:Operative Time