Laparoscopic right hemicolectomy with complete mesocolon excision and cranial approach

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Complete mesocolon excision (CME) and D3-lymphadenectomy are advanced techniques for right colon cancer surgery.
• These methods aim to improve oncological results by ensuring a wider mesocolic excision and central vascular ligation compared to conventional laparoscopic right hemicolectomy (CLRH).
• Challenges include excising lympho-adipose tissue around major mesenteric vessels like the superior mesenteric vein (SMV).

Purpose of the Study:

• To describe a laparoscopic right hemicolectomy (LRH) with complete mesocolon excision (CME) utilizing a cranial approach.
• To demonstrate how this approach facilitates identification of central vascular origins for improved D3-lymphadenectomy.

Main Methods:

• A supramesocolic approach is used, involving opening the gastrocolic ligament to identify the gastrocolic trunk of Henle (GTH) and middle colic artery/vein (MCA/MCV).
• Mobilization of the hepatic flexure and identification of the SMV are performed by dissecting between Gerota and Toldt fascias.
• The dissection follows the embryological plane along the trunk of Gillot (TG) to identify the GTH and its branches, followed by division of relevant vessels and lateral colon mobilization.

Main Results:

• The cranial approach allows for easier identification of the origins of the superior mesenteric vein and its branches.
• This facilitates a true central ligation of vessels, crucial for D3-lymphadenectomy.
• The described technique enables complete mesocolon excision within the embryological planes.

Conclusions:

• Complete mesocolon excision (CME) may enhance oncological outcomes in right colon cancer by providing a more extensive mesocolic resection than D2-lymphadenectomy.
• The cranial approach simplifies the identification of vascular origins, enabling a more accurate central ligation and facilitating CME.