Laparoscopic complete mesocolic excision with radical lymph node dissection along the surgical trunk in right-hemi colon cancer

Shinichiro Mori, MD, Kenji Baba, MD, PhD, Masayuki Yanagi, MD, Yoshiaki Kita, MD, PhD, Shigehiro Yanagita, MD, PhD, Yasuto Uchikado, MD, PhD, Yoshikazu Uenososno, MD, PhD, Hiroshi Okumura, MD, PhD, Akihiro Nakajo, MD, PhD, Kosei Maemura, MD, PhD, Sumiya Ishigami, MD, PhD, Kuniaki Aridome, MD, PhD, Shoji Natsugoe, MD, PhD. Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University.

Background: Laparoscopic colectomy with radical lymph node dissection has been recently accepted in colon cancer. We evaluated the safety and feasibility of laparoscopic complete mesocolic excision (CME) conducted by fusion fascia exposure with radical lymph node dissection along the surgical trunk in the right-hemi colon cancer.

Patients and Methods: We retrospectively analyzed 27 patients with right-hemi colon cancer who underwent laparoscopic CME with radical lymph node dissection between January 2010 and June 2013. Video recordings of the procedure and specimens were utilized to assess the quality of the surgery and CME completion. Operative data, pathological findings, complications and length of hospital stay were also assessed. Surgical procedure: The dissection starts behind the pedicle of ileocolic vessels and proceed along the superior mesenteric vein (SMV). The ileocolic vessels are then cut at their roots. After embryological tissue planes comprising Told’s and pre-renal fascia were exposed, the wide separation between the pancreatic head and the transverse colon is performed. The dissection proceeds along the SMV, exposing the gastrocolic trunk of Henle. The middle colic artery can be identified from superior mesenteric artery and are cut at the roots of the right branch with lymph node dissection. After exposing the gastrocolic trunk of Henle and SMV, the exposure of fusion fascia between the omentum and the transvers mesocolon are performed. And then, the accessory middle colic veins are dissected with lymph node dissection, and transvers mesocolon is dissected below the lower edge of the pancreas, uncovering SMV.

Results: All patients underwent en bloc resection of the enveloped parietal planes with radical lymph node dissection along the surgical trunk without any serious intraoperative complications. Six, three, seven, and eleven patients had T1, T2, T3, and T3 tumors, respectively. The median number of lymph nodes retrieved was 24, with lymph node metastasis identified in 11 patients. According to the UICC cancer staging, the number of patients with stage I, II, II, IV was five, nine, nine and four, respectively. The median operative time and intraoperative blood loss were 290 min (range: 204-420 min) and 41 g (range: 0-145 g), respectively. No postoperative complications occurred in any patient. The median hospital stay after surgery was 11 days.

Conclusions: We propose that laparoscopic CME conducted by fusion fascia exposure with radical lymph node dissection along the surgical trunk is a safe and feasible procedure for right hemicolectomy.

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