Comparative Analysis of the Superior Mesenteric Artery and Modified SMA Approaches in Totally Laparoscopic Radical...

The superior mesenteric artery (SMA) approach aids laparoscopic right colectomy but relies on one landmark. The modified SMA (M-SMA) adds the ligament of Treitz as a second reference to improve safety and efficiency in complex anatomy.

This retrospective analysis included 306 patients who underwent totally laparoscopic radical resection for right-sided colon cancer, divided into the SMA group (n = 147) and the M-SMA group (n = 159). Propensity score matching was applied to balance baseline characteristics. Intraoperative outcomes-including operative time, blood loss, and postoperative complications-were compared between groups.

The M-SMA group demonstrated significantly shorter operative times and reduced intraoperative blood loss (p < .05). The overall postoperative complication rate was also significantly lower in the M-SMA group (11.3% vs. 23.8%, p = .004), with the most notable reduction observed in the incidence of chylous fistula. No significant differences were found in lymph node yield, length of hospital stay, or overall recovery.

The M-SMA approach demonstrates clear perioperative advantages over the traditional SMA technique, including reduced blood loss and a lower complication rate. It may represent a safer and more effective option for patients with complex vascular anatomy undergoing laparoscopic right hemicolectomy.