Retrospective Study
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World J Gastroenterol. Aug 14, 2014; 20(30): 10531-10536
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10531
Techniques and feasibility of laparoscopic extended right hemicolectomy with D3 lymphadenectomy
Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li
Li-Ying Zhao, Hao Liu, Ya-Nan Wang, Hai-Jun Deng, Qi Xue, Guo-Xin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Zhao LY and Liu H contributed equally to the design and preparation of this study and should be considered co-first authors; Zhao LY, Liu H and Li GX designed the research; Wang YN, Deng HJ, Xue Q and Li GX performed the surgeries; Zhao LY and Liu H collected and analyzed the data; Zhao LY and Liu H wrote the paper.
Supported by National High Technology Research and Development Program of China, No. 2012AA021103; the Program of Guangdong Provincial Department of Science and Technology, No. 2012A030400012; the Major Program of Science and Technology Program of Guangzhou, No. 201300000087; and the sub-project under National Science and Technology Support Program, No. 2013BAI05B00
Correspondence to: Guo-Xin Li, MD, PhD, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838, Nort, Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China. gzliguoxin@163.com
Telephone: +86-20-61641682 Fax: +86-20-61641683
Received: November 1, 2013
Revised: March 23, 2014
Accepted: April 28, 2014
Published online: August 14, 2014
Abstract

AIM: To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy (LERH), according to our previous experience.

METHODS: Anatomical relationship and operative techniques were demonstrated. One hundred and five consecutive patients who underwent extended right hemicolectomy with D3 lymphadenectomy between January 2008 and May 2011 were included in the present study [laparoscopic group (n = 48) vs open group (n = 57)].

RESULTS: The right retrocolic space was the main surgical plan of the LERH. The superior mesenteric vein was the most important anatomical landmark for vascular dissection. The medial-to-lateral dissection approach made the LERH performed efficiently. Compared with the open group, the LERH group had less blood loss (111.7 ± 127.8 mL vs 170.2 ± 49.7 mL, P = 0.023), faster return of flatus (3.0 ± 1.6 d vs 3.7 ± 1.3 d, P = 0.019), and earlier diet (4.2 ± 1.4 d vs 5.0 ± 1.2 d, P = 0.005). Five patients (10.4%) underwent conversion during laparoscopic surgery. The cancer recurrence rates between the two groups were comparable (laparoscopic vs open, 8.6% vs 9.1%, P = 0.335).

CONCLUSION: For an advanced tumor located at the hepatic flexure or proximal transverse colon, LERH with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space severed as the surgical plan.

Keywords: Colon cancer, Hepatic flexure, Laparoscopic colectomy, D3 lymphadenectomy, Anatomy

Core tip: Laparoscopic extended right hemicolectomy with D3 lymphadenectomy is technically demanding for complex vascular anatomy. D3 lymphadenectomy can be implemented concisely and safely when the superior mesenteric vein serves as the anatomical landmark and the right retrocolic space severed as the surgical plan.