Laparoscopy-Assisted Right Hemicolectomy with the Bottom-to-Up Approach for Right-Side Colon Cancer

Abstract

We investigated the efficacy and short-term outcomes of laparoscopy-assisted right hemicolectomy using the bottom-to-up approach (LBU-rHC) in right-side colon cancer (rCC) patients. We reviewed 114 patients with rCC underwent LBU-rHC between 2015 and 2019. LBU-rHC Surgical Procedures was shown below. After mobilizing the small intestine to the upper right abdomen, we cut the transition part between the intestinal mesenteric membrane and retroperitoneum near the third part of duodenum (DU). The second part of DU and the pancreatic head (PH), covered with prepancreatic fascia (PPF), is exposed until posterior wall of superior mesenteric vein (SMV) is visible. It is necessary to intentionally transfer from the plane of PPF to retroperitoneum by cutting a membrane of left side the second part of DU when exfoliating between ascending mesocolon and retroperitoneum. By these procedures, it is possible to perform complete mesocolic excision (CME) with central vessel ligation without damaging the PH or DU. After mobilizing the right side colon and mesocolon, we perform right hemicolectomy outside the abdomen. The median operation time was 197.0 min. Intraoperative bleeding was 10 ml. Resumption of oral intake was 3 days after operation. Time to initial flatus/defecation/postoperative discharge from the hospital was 2/3/8 days, respectively. Eleven patients required conversion to laparotomy, most of whom had a history of previous abdominal surgery (P = 0.013). Although 34 patients experienced postoperative morbidity, only 4 were Clavien–Dindo grade ≥ 3. Short-term outcomes indicate that LBU-rHC was safe and enable us to perform accurate CME.