Laparoscopic Right Hemicolectomy Through Medial Access Guided By the Landmark of the Superior Mesenteric Vein (SMV): Report of 105 Cases

Shi Yi, Sun Yueming, Bai Jianfeng. department of minimally invasive surgery , first affiliated hospital of Nanjing medical university

laparoscopic right hemicolectomy through medial access guided by the landmark of the superior mesenteric vein(SMV): Report of 105 cases

BACKGROUND: The laparoscopic approach is increasingly becoming the gold standard for colorectal resections; Although laparoscopic right hemicolectomy has developed less markedly than rectosigmoid resection, probably because of the more complicated regional anatomy and greater difficulty in performing an adequate regional lymphectomy. The aim of this study was to analyse our 5-year experience with laparoscopic right hemicolectomy.
METHODS: Consecutive cases of laparoscopic right hemicolectomies performed between October 2003 and December 2010, in the department of minimally invasive surgery , first affiliated hospital of Nanjing medical university, were compared with a matched series of patients who underwent open surgery. A total of 105 patients were enrolled with non-metastatic right colonic carcinoma, treated laparoscopically (L group) and compared to a group well matched for age, sex, comorbidity and stage of disease, treated with open surgery (O group). Data on the patients’ demographics, operative details, and postoperative complications were collected prospectively. The outcomes of patients with laparoscopic resection were compared with those of patients with open surgery.
RESULTS: All patients successfully underwent laparoscopic right hemicolectomies. None required conversion to an open operation,giving a conversion rate of 0%. The laparoscopic group was characterised by shorter length of incisions (5.25 vs. 16.96cm, p< 0.001) less analgesics postoperatively. The duration of the laparoscopic procedures was slightly longer(146.8 vs. 119.6 min, p < 0.001), but intraoperative blood loss and postoperative stay were reduced compared to the conventional procedure. (49.35±16.83ml vs. 129.52±37.46ml, 8.79±1.95days vs.11.36±2.15days,respectively) . The mean time of passage of flatus was 3 days and 4 days in the laparoscopic and open groups, respectively. There was no difference in postoperative surgically related complications including wound infection, leakage, intestinal obstruction. Nonsurgical-related complications were also similar. Morbidity was similar and there was no 30-day mortality in either group. Specimen length and number of harvested lymph nodes were similar. The 2-year overall survival rates were 92% in both groups (P=0.913). and the 5-year cumulative survival curves showed no statistically significant difference (79.6% versus 75.8%).
CONCLUSION: Our study shows that laparoscopic right hemicolectomy through medial access guided by the landmark of SMV is a safe, effective and oncologically adequate procedure, comparable in all respects to open hemicolectomy, but with all the advantages of the minimally invasive technique.
 


Session: Emerging Technology Poster
Program Number: ETP048
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