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Feasibility of a unidirectionally progressive, pancreas-oriented procedure for laparoscopic D3 right hemicolectomy

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Abstract

Background

Complete mesocolic excision (CME) with central ligation or D3 lymphadenectomy has been reported to provide increased lymph node retrieval with the prospect of superior oncological results in colon cancer. However, right hemicolectomy with CME or D3 lymphadenectomy by laparoscopy is considered to be a technically challenging and time-consuming procedure with a higher risk of causing intraoperative injuries. Here, we introduce a novel laparoscopic approach for the D3 right hemicolectomy and report its feasibility, safety, and efficacy in cancer clearance.

Methods

This purely medial to lateral approach of D3 hemicolectomy was characterized by the following two features: a series of repeated, unidirectional dissections along the superior mesentery vein (SMV) that were started below the ileocolic vein and ended at the pancreatic neck, followed by the exposure of the whole SMV and its colonic branches precisely before the ligation. From January 2012 to December 2015, 58 patients underwent this procedure. The short-term outcomes and long-term survival are reported.

Results

All 58 operations were finished with this procedure successfully, with one injury of the jejunal vein. The mean operation time was 164 ± 28.3 min, the mean blood loss was 64 ± 63.5 ml, and the mean number of retrieved lymph nodes was 28 ± 13.9. No mortality or major morbidity was observed. The 4-year overall survival was 78%, and the disease-free survival was 77%.

Conclusion

This novel, unidirectionally progressive, pancreas-oriented procedure for laparoscopic radical right hemicolectomy with D3 lymphadenectomy is safe and feasible, with the merit of providing an easier and safer way to tackle the variable tributaries of the SMV.

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Acknowledgements

We also thank a doctor of our team, Yazhou He (MD, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; and Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh University, Edinburgh, UK), who revised this manuscript.

Funding

This study was funded by the Scientific and Technology department of Sichuan Province (grant no. 2016SZ0043).

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Author notes

  1. Xiangbing Deng and Tao Hu contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guoxue road 37#, Chengdu, China

    Xiangbing Deng, Tao Hu, Mingtian Wei, Qingbin Wu, Tinghan Yang, Wenjian Meng & Ziqiang Wang

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  1. Xiangbing Deng
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Contributions

Xiangbing Deng and Tao Hu analyzed the data and drafted of manuscript; Tao Hu, Mingtian Wei, Qingbin Wu, and Tinghan Yang contributed for the acquisition and interpretation of the data; Wenjian Meng and Ziqiang Wang revised this manuscript; Wenjian Meng and Ziqiang Wang contributed for the study conception, design, and revision.

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Correspondence to Wenjian Meng.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. In addition, this study was approved by the Ethics Committee of West China Hospital.

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Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

Supplementary Fig 1

the enlarged and vulnerable AIPDVs. Red arrows: AIPDVs; black arrows: RGEV; if the operation ligating the GTH is shown as a white arrow, the AIPDVs may cause troublesome bleeding, and haemostatic procedure may injure the pancreas. (PNG 16020 kb)

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Deng, X., Hu, T., Wei, M. et al. Feasibility of a unidirectionally progressive, pancreas-oriented procedure for laparoscopic D3 right hemicolectomy. Langenbecks Arch Surg 403, 761–768 (2018). https://doi.org/10.1007/s00423-018-1703-0

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