Laparoscopic radical lymphadenectomy with complete mesocolic excision for advanced ascending colon cancer near the hepatic flexure

Dai Uematsu, Gaku Akiyama, Kouji Yamamoto, Akiko Magishi, Takehiko Sugihara. Saku Central Hospital.

Background: Complete mesocolic excision has translated into lower local recurrence rates and better overall survival in colon cancer patients. For cancer of the hepatic flexure of the colon, roughly 5% of lymph nodes over the head of the pancreas are positive. We present a laparoscopic radical lymphadenectomy procedure for advanced ascending colon cancer near the hepatic flexure.

Methods: Between January 2011 and September 2013, 20 consecutive patients with advanced ascending colon cancer near the hepatic flexure underwent curative laparoscopic right hemicolectomy. The mesocolon was dissected between the superficial layer of the fat tissue and the deep layer of the vascular sheath along the superior mesenteric artery. The root of each supplying or draining vessel, such as the ileocolic vessels, right colic vessels, middle colic vessels, and gastrocolic trunk, was exposed and divided. After the omentalbrusa was exposed, the right gastroepiploic vein was divided under the pylorus. The lymph nodes along the right gastroepiploic vein to the gastrocolic trunk were completely removed from the vascular sheath of the right gastroepiploic artery and the surface of the pancreas. Next, the bowel was mobilized and the specimen retrieved through the small incision. Finally, extra-anastomosis was performed.

Results: No intra-operative complications were noted. The median number of retrieved lymph nodes was 38 (range 13-63). Only one positive lymph node was found among all lymph nodes dissected over the head of the pancreas. The median total surgical time was 205 min (range 160-312 min). Surgical blood loss was slight (1-20 mL). The postoperative course was uneventful for all patients.

Conclusions: This laparoscopic method is useful and feasible for ascending colon cancer near the hepatic flexure.

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