Assessment of the Level of Middle Colic Artery Ligation Influence on Survival in Right-Sided Colon Cancer

Aim: This study aims to investigate whether the addition of ligation of the Middle Colic Artery in its origin to Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) affects overall survival and lymph node retrieval. Method: Patients with right-sided colon cancer who underwent curative right or extended right hemicolectomy with CME and CVL were included. In cases with tumors located in the distal part of the ascending colon and the hepatic flexure, the middle colic artery was ligated in its origin. For the cecal and proximal localization of the tumor, the point of ligation was decided on the surgeons' decision. Results: A total number of 169 patients were operated. In 78 patients the tumor was localized in the caecum, in 70 patients in the ascending colon, and 21 in the hepatic flexure. In 59 patients, the middle colic artery was ligated in its origin. Different artery ligation sites according to tumor localization subgroup presented with statistical significance (P = 0.004). The mean number of harvested lymph nodes between the groups was presented with a difference (33.4 vs. 28.5; P = 0.037). Survival rates for cecal, ascending, and hepatic flexure cancer were as follows: 61.5%, 67.1%, and 85.7%, respectively (P = 0.22). The survival rate for all patients was 66.9% (69.5% for patients with middle colic artery ligation and 65.5% for the right branch of middle colic artery ligation, P = 0.42). Conclusion: Ligation of the middle colic artery in its origin did not improve overall survival. However, it resulted in a significantly higher number of harvested lymph nodes.