Laparoscopic radical right hemicolectomy using CtC approach for curable right-sided colon cancer

Liaonan Zou, Guobin Chen, Wenjun Xiong, Yaobin He, Hongming Li, Ping Tan, Wei Wang, Jin Wan. Guangdong Province Hospital of Chinese Medicine

Objective: The aim of this study is to compare the safety, feasibility and short-term outcomes of Laparoscopic radical right hemicolectomy using caudal -to-cranial (CtC) approach versus medial-to-lateral (MtL) approach for curable right-sided colon cancer

Methods: Using data from a clinical database in our department, we retrospectively analyzed data of 78 cases undergoing Laparoscopic radical right hemicolectomy using CtC approach (CtC group) and matched with using medial-to-lateral approach (MtL) group from August 2010 to January 2015. The matching factors consisted of Sex, Gender, Age, ASA score, BMI, Tumor size, Site of tumor , Pathological types, TNM stage , Differentiation of adenocarcinoma. Data of intraoperative and postoperative characteristics were compared between two groups.

Results: The data of clinicopathological characteristics were similar in both groups; there were no significant differences (p > 0.05). All of the operations were successful without conversion to laparotomy. In the intraoperative and postoperative characteristics, there are no significant differences in average time of ambulation, time to first flatus, hospital stay between two groups. (p > 0.05),but there are significantly shorter mean operation time (173.9±25.39 min vs.193.5±39.55 min. p < 0.05) and significantly less mean total blood loss (92.0±21.21ml vs. 107.3±24.67ml. P < 0.05) in the CtC group than that in the MtL group. The number of lymph nodes dissected in the CtC group is more than that in the MtL group(32.2±10.9n vs.22±8.93n . P < 0.05). Although there is no significant differences in the postoperative complication (abdominal infection, lymph leakage, anastomotic leakage, inflammatory intestinal obstruction) in the two groups (p > 0.05),the rate of major blood vessels (SMA,SMV, ICV/ICA, RCV/RCA, Henle’trunk , MCV/MCA) hemorrhage in the CtC group was significantly lower than that in MtL group (14.1% vs. 3.8%. p < 0.05).

Conclusion: Laparoscopic radical right hemicolectomy using caudal-to-cranial (CtC) approach is technically feasible and safer for curable right-sided colon cancer based on embryological anatomical logic.It is easy to enter the correct anatomical Toldts space and easy to dissect the Superior Mesenteric Vein (SMV) and its branches. The procedures are obviously faster and much less bleeding, more conducive to shorten the learning curve, and the short-term effects are satisfactory.

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