Abstract
We investigated the efficacy and short-term outcomes of laparoscopy-assisted right hemicolectomy using the bottom-to-up approach (LBU-rHC) in right-side colon cancer (rCC) patients. We reviewed 114 patients with rCC underwent LBU-rHC between 2015 and 2019. LBU-rHC Surgical Procedures was shown below. After mobilizing the small intestine to the upper right abdomen, we cut the transition part between the intestinal mesenteric membrane and retroperitoneum near the third part of duodenum (DU). The second part of DU and the pancreatic head (PH), covered with prepancreatic fascia (PPF), is exposed until posterior wall of superior mesenteric vein (SMV) is visible. It is necessary to intentionally transfer from the plane of PPF to retroperitoneum by cutting a membrane of left side the second part of DU when exfoliating between ascending mesocolon and retroperitoneum. By these procedures, it is possible to perform complete mesocolic excision (CME) with central vessel ligation without damaging the PH or DU. After mobilizing the right side colon and mesocolon, we perform right hemicolectomy outside the abdomen. The median operation time was 197.0 min. Intraoperative bleeding was 10 ml. Resumption of oral intake was 3 days after operation. Time to initial flatus/defecation/postoperative discharge from the hospital was 2/3/8 days, respectively. Eleven patients required conversion to laparotomy, most of whom had a history of previous abdominal surgery (P = 0.013). Although 34 patients experienced postoperative morbidity, only 4 were Clavien–Dindo grade ≥ 3. Short-term outcomes indicate that LBU-rHC was safe and enable us to perform accurate CME.
Similar content being viewed by others
References
National Cancer Center Japan (2018) Projected Cancer Statistics. Research Center for Cancer Control and Information Services, Cancer Information Service. Available from: http://ganjoho.jp/en/index.html. Accessed 20 April 2020
Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–664
Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52
Jayne DG, Thorpe HC, Copeland J et al (2020) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645
Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7
Bae SU, Saklani AP, Lim DR, Kim DW, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2014) Laparoscopic-assisted versus open complete mesocolic ecision and central vascular ligation for right-sided colon cancer. Ann Surg Oncol 21:2288–2294
Liang JT, Lai HS, Huang J, Sun CT (2015) Long-term oncologic results of laparoscopic D3 lymphadenectomy. Surg Endosc 29:2394–2401
Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gögenur I, Danish Colorectal Cancer Group (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16:161–168
Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, Yin M, Yang X, Wang S, Ye Y (2017) Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Color Dis 19:962–972
Merkel S, Weber K, Matzel KE, Agaimy A, Göhl J, Hohenberger W (2016) Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision. Br J Surg 103:1220–1229
West NP, Morris EJ, Rotimi O et al (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9:857–865
Hohenberger W, Weber K, Matzel K et al (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis 11:354–364 discussion 364-365
Zurleni T, Cassiano A, Gjoni E, Ballabio A, Serio G, Marzoli L, Zurleni F (2018) Surgical and oncological outcomes after complete mesocolic excision in right-sided colon cancer compared with conventional surgery: a retrospective, single-institution study. Int J Color Dis 33:1–8
Zou L, Xiong W, Mo D, He Y, Li H, Tan P, Wang W, Wan J (2016) Laparoscopic radical extended right hemicolectomy using a caudal-to-cranial approach. Ann Surg Oncol 23:2562–2563
Schulte Am Esch J, Iosivan SI, Steinfurth F et al (2019) A standardized suprapubic bottom-to-up approach in robotic right colectomy: technical and oncological advances for complete mesocolic excision (CME). BMC Surg 19:72
Matsuda T, Iwasaki T, Mitsutsuji M, Hirata K, Maekawa Y, Tanaka T, Shimada E, Kakeji Y (2015) Cranial-to-caudal approach for radical lymph node dissection along the surgical trunk in laparoscopic right hemicolectomy. Surg Endosc 29:1001
Author information
Authors and Affiliations
Contributions
KT made a substantial contribution to the conception of the study, conducted a literature search, and drafted the manuscript. KT and TY contributed to the acquisition of the data. KT, TY, YM, and YU performed the operation. KT and KY reviewed the manuscript and gave final approval for the publication. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflicts of interest.
Ethical Approval
This case series analysis was conducted in accordance with World Medical Association Declaration of Helsinki and all its amendments and was approved by the ethics committees at Kansai Medical University Medical Center. Approval code issued by the institutional review board (IRB) is 2020073.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tokuhara, K., Yoshida, T., Matsui, Y. et al. Laparoscopy-Assisted Right Hemicolectomy with the Bottom-to-Up Approach for Right-Side Colon Cancer. Indian J Surg 83, 1178–1184 (2021). https://doi.org/10.1007/s12262-020-02618-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-020-02618-9