Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Department of Surgery, Yokohama City University, Yokohama, Japan.
Tech Coloproctol. 2021 Feb;25(2):223-227. doi: 10.1007/s10151-020-02388-2. Epub 2021 Jan 18.
Complete mesocolic excision with central vessel ligation may be important for accurate staging and improving the prognosis of right-sided colon cancer. Although the procedure is often performed laparoscopically, approaching the middle colic artery (MCA) is technically demanding, especially when complete ligation of arteries at their roots is desired. We standardized our laparoscopic approach by establishing the dissection boundary along the superior mesenteric artery to achieve D3 lymphadenectomy in the region of the MCA. The aim of the present study was to evaluate, on the basis of perioperative and short-term oncologic outcomes, the feasibility and safety of our technique METHODS: We conducted a retrospective study on consecutive patients with cancer located at the ascending colon and transverse colon who had laparoscopic right hemicolectomy requiring ligation of the MCA.
There were 41 patients (22 males, median age 71 years [range 49-86] years). The median operation time was 285 min, and blood loss volume was 40 mL. Conversion to open surgery was required in 1 case. Complications that were Clavien-Dindo grade III or above occurred in 3 patients (7.3%). There was no anastomotic leakage. The median number of lymph nodes harvested was 46.
Our technique was shown to be a safe, feasible, and useful strategy for performance of right hemicolectomy requiring ligation of the MCA in cases of colon cancer. The technique facilitates maximal lymph node dissection. Having obtained favorable outcomes, we look forward to investigation into long-term outcomes.
完整的结肠系膜切除术联合中央血管结扎术对于右半结肠癌的准确分期和改善预后可能非常重要。虽然该手术通常采用腹腔镜进行，但对于中间结肠动脉（MCA）的处理具有一定的技术难度，尤其是当需要完全结扎根部的动脉时。我们通过在肠系膜上动脉的边界处建立解剖边界，实现了 MCA 区域的 D3 淋巴结清扫，从而标准化了腹腔镜方法。本研究旨在根据围手术期和短期肿瘤学结果，评估我们的技术的可行性和安全性。
我们对连续接受腹腔镜右半结肠切除术且需要结扎 MCA 的升结肠和横结肠癌患者进行了回顾性研究。
共纳入 41 例患者（22 例男性，中位年龄 71 岁[范围 49-86]岁）。中位手术时间为 285 分钟，出血量为 40 毫升。1 例患者中转开腹。3 例患者发生 Clavien-Dindo 分级Ⅲ级或以上的并发症（7.3%）。无吻合口漏。中位淋巴结清扫数目为 46 枚。
我们的技术在结肠癌患者中，对于需要结扎 MCA 的右半结肠切除术是一种安全、可行且有效的策略。该技术有利于最大限度地进行淋巴结清扫。我们取得了良好的结果，期待进一步研究长期结果。
