Feasibility of a unidirectionally progressive, pancreas-oriented procedure for laparoscopic D3 right hemicolectomy

Complete mesocolic excision (CME) with central ligation or D3 lymphadenectomy has been reported to provide increased lymph node retrieval with the prospect of superior oncological results in colon cancer. However, right hemicolectomy with CME or D3 lymphadenectomy by laparoscopy is considered to be a technically challenging and time-consuming procedure with a higher risk of causing intraoperative injuries. Here, we introduce a novel laparoscopic approach for the D3 right hemicolectomy and report its feasibility, safety, and efficacy in cancer clearance.

This purely medial to lateral approach of D3 hemicolectomy was characterized by the following two features: a series of repeated, unidirectional dissections along the superior mesentery vein (SMV) that were started below the ileocolic vein and ended at the pancreatic neck, followed by the exposure of the whole SMV and its colonic branches precisely before the ligation. From January 2012 to December 2015, 58 patients underwent this procedure. The short-term outcomes and long-term survival are reported.

All 58 operations were finished with this procedure successfully, with one injury of the jejunal vein. The mean operation time was 164 ± 28.3 min, the mean blood loss was 64 ± 63.5 ml, and the mean number of retrieved lymph nodes was 28 ± 13.9. No mortality or major morbidity was observed. The 4-year overall survival was 78%, and the disease-free survival was 77%.

This novel, unidirectionally progressive, pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy is safe and feasible, with the merit of providing an easier and safer way to tackle the variable tributaries of the SMV.