Xiaojiang Yi, Dechang Diao. Department of Gastrointestinal (Tumor) Surgery, Guangdong Province Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine
Objective: To explore the feasibility and application value of “caudal to cranial” approach plus D3 lymph node dissection around the superior mesenteric artery for the treatment of right hemi-colon cancer.
Methods: Clinical data of 164 cases of right hemicolon cancer undergoing laparoscopic D3+CME radical resection, including 84 cases of “caudal to cranial” approach plus dissection around the superior mesenteric artery (CC+SMA group) and 84 cases of conventional medial approach plus dissection around the superior mesenteric vein (MA+SMV group), from January 2017 to March 2018 were retrospectively analyzed. For CC+SMA group, our method was to incise the membrane bridge of ileocecal section (Tri-junction of mesostenium and mesocolon), enter the Toldt's space and isolated the retroperitoneal space behind the mesentery without touching the tumor. Along the midline of SMA, blood supply vessels were ligated from the caudal to cranial, and isolating the gastrocolonic ligaments, close to the lower edge of the liver, and coming back to free lateral ligaments.
Results: The baseline information was not significantly different between the two groups (all P > 0.05). The mean operation time in the CC+SMA and the MA+SMV group was 170.0 and 172.3 min respectively, which has no significant difference (P>0.05). The mean number of harvested lymph nodes in the two groups were 29.4 and 26.2 respectively (P<0.05), which was significantly different. 4 cases of chylous leakage occurred in the CC+SMA group, which was similar with MA+SMV group (3 cases). Compared with the MA+SMV group, there was no significant difference in the operative blood loss, postoperative time to flatus and postoperative hospitalization time in the CC+SMA group (P>0.05). All patients were followed up for more than 6 months, and there was no 30-day re-hospitalization and mortality.
Conclusion: It is safe and feasible for “caudal to cranial” approach plus D3 lymph node dissection around the superior mesenteric artery in right hemi-colon cancer. It may have some advantages i lymph nodes harvest and long term prognosis remains to be expected.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95698
Program Number: S036
Presentation Session: Colorectal I
Presentation Type: Podium