Laparoscopic caudal-to-cranial approach for radical lymph node dissection in right hemicolectomy.
OBJECTIVE
The present study evaluated the safety and feasibility of this caudal-to-cranial laparoscopic dissection approach for the curative resection of right-sided colon cancer. To the best of our knowledge, no study has reported the caudal-to-cranial approach in the laparoscopic right colectomy with curative intent for colon cancer.


METHODS
The key procedure of the caudal-to-cranial approach is the commencement of the dissection at the mesentery root, thus entering into the Toldt's space before the mesenteric vessels are accessed. We retrospectively analyzed the data obtained from a prospectively established database on 80 consecutive patients who had undergone laparoscopic right hemicolectomy with caudally approached radical lymph node dissection for curable right-sided colon cancer between June 2014 and June 2015.


RESULTS
There were 38 male and 42 female patients, with a mean age of 72.5 years (range, 53-83) and a mean BMI of 22.1 kg/m(2) (16.5-35.2). All procedures were successful without any serious intraoperative complications or any conversion to open surgery. The mean operation time was 178.3 min (range, 150-215), and the mean blood loss was 81.6 ml (range, 50-200). The mean number of harvested lymph nodes was 19 (range, 12-25).


CONCLUSIONS
The findings indicate that laparoscopic caudal-to-cranial approach for radical lymph node dissection is a feasible and safe procedure for the treatment of curable right-sided colon cancer.
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, Guangdong Province, 510120, China.
Hongming
H
Li
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, Guangdong Province, 510120, China.
Yaobin
Y
He
Geriatric Department of General Hospital of Guangzhou Military Command of PLA, No.111, Liuhua Road, Guangzhou, Guangdong Province, 510010, China.
Zhongqiu
Z
Lin
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, Guangdong Province, 510120, China.
Wenjun
W
Xiong
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, Guangdong Province, 510120, China.
Dechang
D
Diao
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, Guangdong Province, 510120, China.
Wei
W
Wang
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, Guangdong Province, 510120, China.
Jin
J
Wan
Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Guangzhou, Guangdong Province, 510120, China. zouliaonan02@sina.com.
Liaonan
L
Zou
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery*; D004210:Dissection; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies
Caudal-to-cranial approach; Colon cancer; Laparoscopic surgery; Right hemicolectomy