L. Zou1, B. Zheng2, Y. He1, L. Zou1 1Guangdong Hospital of Traditional Chinese Medicine, Zhuhai,Department Of General Surgery,Zhuhai, GUANGDONG, China 2Brookdale Hospital and Medical Center,Department Of General Surgery,Brooklyn, NEW YORK, USA
Introduction: Currently? the medial-to-lateral approach is widely used in laparoscopic right colectomy. However, this approach is unable to dissect lymph nodes located posterior to the superior mesenteric vessels. Our aim is to discuss the necessity and clinical significance of using the caudal-to-cranial approach in laparoscopic right colectomy.
Methods: This is a prospective cohort study. A total of 78 consecutive patients (between 2014 and 2017) with advanced right colon cancer (TNM stage I: 17; stage II: n = 23; stage III: n = 38) requiring a curative right colectomy were subjected to laparoscopic caudal-to-cranial approach. All patients received preoperative nanocarbon injections around the tumor via colonoscopy. Lymph nodes were then analyzed and the positive rate of the lymph nodes was calculated.
Results: In this follow-up study, 45 male and 33 female patients(age 63.6±10.59 years old ) with mean body mass index of 21.7±2.87 kg/m2. The mean operation time was 153.9±25.36 min, and the mean blood loss was 82.0±19.21 ml. The mean tumor size was 5.3±1.1 cm and the mean number of harvested lymph nodes was 19.68±7.56 with an average of 1.53±2.75(7.8%) positive lymph nodes . Of these positive lymph nodes, 1.1±4.69 were posterior to superior mesenteric vessels, with a positive rate of 1.3%. All procedures were successful without any serious intraoperative complications, conversion to open surgery, or surgical mortalities.
Conclusion: There are positive lymph nodes posterior to the superior mesenteric vessels in progressive right colon cancers. We suggest a complete dissection of these lymph nodes to reach radical treatment by using a caudal- to-cranial approach.
