Cranial-to-caudal approach in laparoscopic surgery for left-sided colon cancer: Longer specimens and higher lymph...

Medial-to-lateral (ML) approach is the standard technique in laparoscopic surgery for left-sided colon cancer. However, it can be technically challenging; such as in patients with intra-abdominal adhesions or during splenic flexure mobilization. To overcome these difficulties, we adopted a cranial-to-caudal (CC) approach as an alternative technique. This study aimed to compare the CC and ML approaches in terms of short-term clinical and mid-term oncological outcomes.

Patients performed laparoscopic surgery for left-sided colon cancer between October 2018 and November 2022 were retrospectively analyzed. Patients were classified into two groups. The primary outcome was the length of the resected specimen. Secondary outcomes were pathological parameters, perioperative outcomes, recurrence-free survival (RFS) and overall survival (OS).

Seventy-four patients were included (ML, n = 39; CC, n = 35). The CC group had longer specimen lengths compared with the ML group (32.9 ± 6.8 cm vs 28.9 ± 6.4 cm; p = 0.022), and longer proximal margin (11.8 ± 3.3 cm vs 9.9 ± 2.3 cm; p = 0.004). Lymph node yield was also higher in the CC group (26.4 ± 8.7 vs 22.3 ± 6.5; p = 0.033). On multivariable analysis, specimen length was independently associated with lymph node yield (β = 0.73; 95% CI, 0.47-1.20; p < 0.001). During a mean follow-up of 44 months, RFS (88.6% vs 89.7%; p = 0.84) and OS (88.6% vs 87.2%; p = 0.67) were similar between the groups.

In laparoscopic surgery for left-sided colon cancer, the CC approach yielded longer resected specimens and more lymph node counts compared with the ML approach, but did not improve oncologic outcomes.