Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;407(1):409-419.
doi: 10.1007/s00423-021-02267-w. Epub 2021 Jul 13.

Modified complete mesocolic excision with central vascular ligation by the squeezing approach in laparoscopic right colectomy

Nobuki Ichikawa  1 , Shigenori Homma  2 , Tadashi Yoshida  1 , Shin Emoto  1 , Ken Imaizumi  1 , Yoichi Miyaoka  1 , Hiroki Matsui  1 , Akinobu Taketomi  1
Affiliations

Modified complete mesocolic excision with central vascular ligation by the squeezing approach in laparoscopic right colectomy

Nobuki Ichikawa et al. Langenbecks Arch Surg. 2022 Feb.

Abstract

Purpose: Complete mesocolic excision (CME) and central vascular ligation (CVL) are becoming the standard procedure in laparoscopic right-sided colectomy. However, the approach to CME and CVL has not been established, although several useful approaches have been reported. The squeezing approach described herein is a novel procedure to perform modified CME and CVL in laparoscopic right colectomy.

Methods: The squeezing approach features retroperitoneal mobilization followed by cranial mesocolic mobilization and lymph node dissection using a cranial approach followed by a caudal approach. Dissection of the regional lymph nodes along with central vascular ligation was performed along the anterior wall of the superior mesenteric vein. In total, 177 patients (mean age, 70.6 years; male-to-female ratio, 90:87) who underwent laparoscopic right-sided colectomy were retrospectively assessed. Descriptive statistics for patient characteristics were calculated.

Results: The mean operative time and blood loss were 169 min and 37 mL, respectively. Seven patients (4.0%) required conversion to open surgery, and major postoperative complications occurred in five patients (2.8%) with no anastomotic leakage. Histological R0 resection was achieved in all cases of stages 0-III colon cancer. The 5-year recurrence-free survival rates were 100% (n = 19), 100% (n = 40), 87% (n = 46), and 81% (n = 43) in pathological stages 0, I, II, and III, respectively. Node recurrence occurred in one case near the root of the middle colic artery.

Conclusion: The novel squeezing approach in laparoscopic right colectomy could be safely performed in terms of the technical and oncological aspects.

Keywords: Central vascular ligation; Colon cancer; Complete mesocolic excision; Feasibility; Laparoscopic; Right colectomy.

PubMed Disclaimer

References

    1. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, Beart RW, Hellinger M, Flanagan R, Peters W, Ota D (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059. https://doi.org/10.1056/nejmoa032651 - DOI
    1. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group, (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726. https://doi.org/10.1016/s0140-6736(05)66545-2 - DOI - PubMed
    1. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S, Japan Clinical Oncology Group Colorectal Cancer Study Group (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260:23–30. https://doi.org/10.1097/sla.0000000000000499 - DOI
    1. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52. https://doi.org/10.1016/s1470-2045(08)70310-3 - DOI - PubMed
    1. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW, Hellinger M, Flanagan R, 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 246:655-662; discussion 662. https://doi.org/10.1097/sla.0b013e318155a762

LinkOut - more resources