Improved Nodal Yields in Laparoscopic Right Hemicolectomy Using Intracorporeal Technique—A Comparative Study

Abstract

AbstractRight-sided colon cancer is now commonly treated by laparoscopic right hemicolectomy (LRH). The best procedure for mesentery dissection and nodal harvesting is still being debated. The purpose of this study is to compare precise intra-corporeal mesentery dissection (ICMD) with extra-corporeal mesentery dissection (ECMD) approaches and assess their impact on nodal harvest during LRH. This paper is also aimed at providing a detailed account of the customised intracorporeal dissection technique. A retrospective analysis of 78 operative cases was performed. The patients were divided into two groups: those with ICMD (n = 30) and those with ECMD (n = 48). The total number of lymph nodes extracted was the primary outcome. The number of positive lymph nodes, length of hospital stay, and surgical complications were some of the secondary objectives. The total number of lymph nodes extracted in the ICMD was considerably higher (p = 0.02). Cancers located in the ascending colon were associated with more lymph nodes than tumours located in the cecum or hepatic flexure (p = 0.001). This study demonstrates that ICMD provides improved nodal yield compared to ECMD in LRH for right-sided colon cancer. The anatomical location of cancer also impacts the nodal number, with tumours in the ascending colon having the highest yield. The findings underscore the importance of precise dissection technique selection to optimise oncological outcomes, suggesting potential further enhancements with the use of robotic surgical systems in accessing challenging anatomical locations.