Laparoscopic complete mesocolic excision with true central vascular ligation for right-sided colon cancer

Complete mesocolic excision (CME) is known to be effective for colon cancer. However, in right-sided colon cancer, central vascular ligation (CVL) is not easy to perform. In particular, in patients in whom the superior mesenteric vein (SMV) runs on the ventral side of the superior mesenteric artery (SMA) (Type V/A), laparoscopic ligation of the artery at its root is extremely difficult compared with this procedure in patients in whom the SMA runs on the ventral side of the SMV (Type A/V).

We started performing laparoscopic CME with true CVL for right-sided colon cancer using the SMA as a landmark in 2015, and by 2019, we had completed it for 60 patients. To start, the mesocolon is opened well to the caudal side of the ileocolic vessels. The mesentery is then fully detached from the retroperitoneal tissue, after which the ileocolic vessels are ligated at their roots. D3 lymph node dissection of the lymph nodes around the SMA and SMV on the resection side is also performed using the SMA as a landmark, and depending on the location of the tumor, the roots of the right and middle colic vessels are ligated and divided. This study was conducted with the approval of the Tokyo Medical University Ethics Committee. All patients provided informed consent.

The tumor was located in the cecum in 21 cases, the ascending colon in 33, and the transverse colon in 6. The mean operating time was 229 min and the mean volume of hemorrhage was 67 ml. There was one Clavien-Dindo Grade 3 or worse postoperative complication (ileus). There were no surgery-related or in-hospital deaths.

This procedure can be performed comparatively safely. However, since it requires some skill, we consider that it should only be performed in suitable cases by teams with sufficient experience.