BACKGROUND: The role of laparoscopic colon resection in the management of colon cancer is still controversial. In this article, the surgical strategy and techniques are described, with further consideration of the oncologically relevant aspects. METHODS: Between March 1993 and July 2003, we performed laparoscopic right hemicolectomy in 56 patients with right colon carcinoma. Average age was 74.5 years (range, 17-92). We performed a standardized surgical procedure that included mobilization from the vascularized mesenteric bridges with a window technique, transection of the ileocolic lymphovascular pedicle, and lateral and proximal mobilization of the ileocecum, ascending colon, right flexure, and proximale transversum. After enlargement of one of the trocar incisions the exteriorized colon was resected and an extracorporeal anastomosis was performed in the standard manner. RESULTS: There were no conversions to open. The mean operating time was 119 +/- 38 min, the mean length of resected colon was 27.8 +/- 4.48 cm, and the average width of the clear margins was 6.8 +/- 5.3 cm. One patient died. Lymph nodes were positive in 21 patients. The 5-year survival rate in the 48 patients who were operated on with curative intent was 75%. We have had two local recurrences. The overall 5-year mortality-free fraction was 63%. Cox multivariate analysis showed that the mortality-prognostic factors were tumor stage and length of resected colon, whereas Kaplan-Meier analysis showed that the mortality-prognostic factors were positive lymph nodes and tumor stage. CONCLUSIONS: Our results show that laparoscopic right hemicolectomy for colon cancer can be performed safely. Complications and recurrence rates are comparable to those for left-sided laparoscopic and open procedures. Therefore, we recommend this procedure as the method of choice. Laparoscopically treated patients with stage II and stage III disease have almost the same cumulative rate of survival.
BACKGROUND: The role of laparoscopic colon resection in the management of colon cancer is still controversial. In this article, the surgical strategy and techniques are described, with further consideration of the oncologically relevant aspects. METHODS: Between March 1993 and July 2003, we performed laparoscopic right hemicolectomy in 56 patients with right colon carcinoma. Average age was 74.5 years (range, 17-92). We performed a standardized surgical procedure that included mobilization from the vascularized mesenteric bridges with a window technique, transection of the ileocolic lymphovascular pedicle, and lateral and proximal mobilization of the ileocecum, ascending colon, right flexure, and proximale transversum. After enlargement of one of the trocar incisions the exteriorized colon was resected and an extracorporeal anastomosis was performed in the standard manner. RESULTS: There were no conversions to open. The mean operating time was 119 +/- 38 min, the mean length of resected colon was 27.8 +/- 4.48 cm, and the average width of the clear margins was 6.8 +/- 5.3 cm. One patient died. Lymph nodes were positive in 21 patients. The 5-year survival rate in the 48 patients who were operated on with curative intent was 75%. We have had two local recurrences. The overall 5-year mortality-free fraction was 63%. Cox multivariate analysis showed that the mortality-prognostic factors were tumor stage and length of resected colon, whereas Kaplan-Meier analysis showed that the mortality-prognostic factors were positive lymph nodes and tumor stage. CONCLUSIONS: Our results show that laparoscopic right hemicolectomy for colon cancer can be performed safely. Complications and recurrence rates are comparable to those for left-sided laparoscopic and open procedures. Therefore, we recommend this procedure as the method of choice. Laparoscopically treated patients with stage II and stage III disease have almost the same cumulative rate of survival.
Authors: E Lezoche; F Feliciotti; M Guerrieri; A M Paganini; A De Sanctis; R Campagnacci; G D'Ambrosio Journal: Minerva Chir Date: 2003-08 Impact factor: 1.000
Authors: C A Anderson; F R Kennedy; M Potter; H L Opie; S Flowers; S Lewis; M Belmont; D L Fowler Journal: Surg Endosc Date: 2001-12-10 Impact factor: 4.584
Authors: J W Fleshman; H Nelson; W R Peters; H C Kim; S Larach; R R Boorse; W Ambroze; P Leggett; R Bleday; S Stryker; B Christenson; S Wexner; A Senagore; D Rattner; J Sutton; A P Fine Journal: Dis Colon Rectum Date: 1996-10 Impact factor: 4.585
Authors: P Vukasin; A E Ortega; F L Greene; G D Steele; A J Simons; G J Anthone; L A Weston; R W Beart Journal: Dis Colon Rectum Date: 1996-10 Impact factor: 4.585
Authors: Marco Milone; Ugo Elmore; Enrico Di Salvo; Paolo Delrio; Luigi Bucci; Giuseppe Paolo Ferulano; Carmine Napolitano; Maria Rachele Angiolini; Umberto Bracale; Marco Clemente; Michele D'ambra; Gaetano Luglio; Mario Musella; Ugo Pace; Riccardo Rosati; Francesco Milone Journal: Surg Endosc Date: 2014-11-21 Impact factor: 4.584
Authors: Marco Scatizzi; Katrin C Kröning; Andrea Borrelli; Gordon Andan; Elisa Lenzi; Francesco Feroci Journal: World J Surg Date: 2010-12 Impact factor: 3.352
Authors: N A Rotholtz; M Laporte; G Zanoni; M E Bun; L Aued; S Lencinas; N A Mezzadri; L Pereyra Journal: Tech Coloproctol Date: 2008-05-30 Impact factor: 3.781