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Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies

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Abstract

Objective

This study was designed to investigate the feasibility and technical strategies of laparoscopic complete mesocolic excision (CME) for right-hemi colon cancer.

Methods

The clinical and pathological findings of 64 patients with right-hemi colon cancer who underwent laparoscopic CME between March 2010 and September 2011 were collected retrospectively. Among them, 35 cases were eligible for the final analysis through various screening factors. The quality of surgery also was assessed by reviewing the recorded video obtained through the operations in terms of specimen anatomic planes and completeness of the excised mesocolon.

Results

Laparoscopic CME is focused on applying the concept of enveloped visceral and parietal planes during the operations. Laparoscopic approach proceeds with medial access where the dissection starts at ileocolic vessel before proceeds along with the superior mesenteric vessel. The access also emphasized en bloc resection of mesocolon without defections to the planes. Besides, lymph node resections at the root of ileocolic; right colic and middle colic vessels are necessary for ileocecum cancer. Cancers at the hepatic flexure requires further dissection of subpyloric lymph nodes and of greater omentum that is within 15 cm of the tumor and along the greater curvature. Thirty-five cases were evaluated as good plane. The median total number of central lymph nodes retrieved was 19 (range, 15–25) and central lymph node metastasis was found in 5 of all stage III cases. The median operation time was 2.6 h and the blood loss was 80 mL. The median time for passage of flatus and hospitalization were 2 and 12 days respectively. Complications were observed in three cases.

Conclusions

CME is a novel concept for colon cancer surgery and might be a standard for the procedure. Laparoscopic CME with medial access is technically feasible and randomized trials are needed to evaluate its long-term outcomes.

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Acknowledgments

The authors’ gratefully acknowledge the Science and Technology Commission of Shanghai Municipality, Shenkang Center of Hospital Development and the Foundation for Discipline Leaders of Science in Shanghai for financial support (1141195070, 11411950701, SHDC12010116, 10XD1402700). In addition, our authors deeply appreciate the contributions of all the coworkers and friends to this study and, furthermore, appreciate the editors and reviewers for their help with the manuscript.

Disclosures

Authors Bo Feng, Jing Sun, Tian-Long Ling, Ai-Guo Lu, Ming-Liang Wang, Xue-Yu Chen, Jun-Jun Ma, Jian-Wen Li, Lu Zang, Ding-Pei Han and Min-Hua Zheng have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 197, Ruijin er Road, Shanghai, 200025, People’s Republic of China

    Bo Feng, Jing Sun, Tian-Long Ling, Ai-Guo Lu, Ming-Liang Wang, Xue-Yu Chen, Jun-Jun Ma, Jian-Wen Li, Lu Zang, Ding-Pei Han & Min-Hua Zheng

  2. Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, People’s Republic of China

    Bo Feng, Jing Sun, Tian-Long Ling, Ai-Guo Lu, Ming-Liang Wang, Xue-Yu Chen, Jun-Jun Ma, Jian-Wen Li, Lu Zang, Ding-Pei Han & Min-Hua Zheng

  3. Minhang Branch of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People’s Republic of China

    Min-Hua Zheng

  4. Shanghai Institute of Digestive Surgery, Shanghai, 200025, People’s Republic of China

    Jing Sun, Tian-Long Ling, Xue-Yu Chen & Ding-Pei Han

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  1. Bo Feng
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  8. Jian-Wen Li
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  9. Lu Zang
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  11. Min-Hua Zheng
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Corresponding authors

Correspondence to Ai-Guo Lu or Min-Hua Zheng.

Additional information

Bo Feng and Jing Sun contributed equally to this study as first author(s).

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Feng, B., Sun, J., Ling, TL. et al. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc 26, 3669–3675 (2012). https://doi.org/10.1007/s00464-012-2435-9

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  • DOI: https://doi.org/10.1007/s00464-012-2435-9

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