The safety, feasibility and clinical application of laparoscopic radical right hemicolectomy using a caudal-to-cranial approach

Abstract

Objective To investigate the safety, feasibility and efficacy of laparoscopic radical right hemicolectomy using a caudal-to-cranial approach. Methods From January 2014 to December 2015, 90 cases with curable right-side colon cancer underwent laparoscopic radical right hemicolectomy using a caudal-to-cranial approach. The general clinical characteristics, intraoperative and postoperative outcomes were analyzed retrospectively. Results All 90 cases underwent laparoscopic surgery successfully. The overall complication rate was 11.1%. One patient (1.1%) had intraoperative ileocolic artery bleeding due to violent retraction and was then successfully managed through a small incision. The total postoperative complication rate was 11.1%, three cases (3.3%) with pulmonary infection, two (2.2%) urinary system infection, one (1.1%) wound infection, two (2.2%) inflammatory bowel obstruction and one (1.1%) lymph fistula, all treated conservatively with no reoperation. The mean blood loss was 68.4±37.9 ml, mean operative time 146.8±30.5 min , time of first flatus 49.7±21.5 hours , liquid diet 58.1±13.2 hours. The postoperative hospital stay was 7.8±3.2 day. The mean number of lymph nodes harvested was 29.8±9.9, and the mean positive lymph nodes was 4.1±2.1. Conclusions The caudal-to-cranial approach is safe and feasible for laparoscopic radical right hemicolectomy; it meets the principle of surgical oncology and may be helpful to shorten the learning curve of laparoscopic right hemicolectomy. Key words: Colorectal neoplasms; Laparoscopy; Caudal-to-cranial approach; Therapeutic uses