Stefan Benz1, Yu Tam2, Andrea Tannapfel2, Ingo Stricker2. 1. Klinik für Allgemein, Viszeral und Kinderchirurgie, Kliniken Böblingen, Bunsenstr. 120, 71032, Böblingen, Germany. stefanrolfbenz@web.de. 2. Institut für Pathologie, Ruhruniversität Bochum, Bochum, Germany.
Abstract
BACKGROUND: Current evidence suggests that complete mesocolic excision (CME) for right-sided colon cancer could be beneficial in terms of long-term survival. However, CME is a considerably more complex operation than standard right hemicolectomy; this is especially true for the laparoscopic approach. Consequently, we have explored a new laparoscopic approach that provides surgical radicality at the mesenteric root on the one hand and maximum safety on the other hand. METHODS: The key feature of the uncinate process first approach (UFA) is the commencement of the dissection at the fourth part of the duodenum using a medial to lateral approach, thus mobilizing the whole mesenteric root posteriorly before the central parts of the mesenteric vessels are accessed. Twenty-eight selected patients with right-sided colon cancer underwent surgery using the UFA and were compared with 51 patients who underwent an open CME procedure (CON). In 11/28 and 51/51 patients in the UFA and CON groups, respectively, a planimetric assessment of the specimen was performed. RESULTS: Surgical time was longer (144.8 vs. 202.5 min; p < 0.000) and postoperative stay shorter (8.0 vs. 10.5 days; p < 0.01) for the laparoscopic approach. The area of the resected mesentery (UFA, 15,097 mm(2); CON, 15,788 mm(2); p = 0.47) and the lymph node count (UFA, 59.0; CON, 51.0; p = 0.09) was not significantly different; additionally, no difference was observed regarding anastomotic leakage (both n = 0) and postoperative mortality (UFA, 0/28; CON, 1/51; p = 1.0). CONCLUSION: Laparoscopic right hemicolectomy with CME using the UFA provides adequate radicality according to the CME principles and seems feasible and as safe as an open technique. However, future trails will have to demonstrate whether the theoretical advantages of the UFA, with a higher degree of mobility and accessibility of the mesenteric root, translate into a significant clinical benefit, especially relative to the other laparoscopic techniques.
BACKGROUND: Current evidence suggests that complete mesocolic excision (CME) for right-sided colon cancer could be beneficial in terms of long-term survival. However, CME is a considerably more complex operation than standard right hemicolectomy; this is especially true for the laparoscopic approach. Consequently, we have explored a new laparoscopic approach that provides surgical radicality at the mesenteric root on the one hand and maximum safety on the other hand. METHODS: The key feature of the uncinate process first approach (UFA) is the commencement of the dissection at the fourth part of the duodenum using a medial to lateral approach, thus mobilizing the whole mesenteric root posteriorly before the central parts of the mesenteric vessels are accessed. Twenty-eight selected patients with right-sided colon cancer underwent surgery using the UFA and were compared with 51 patients who underwent an open CME procedure (CON). In 11/28 and 51/51 patients in the UFA and CON groups, respectively, a planimetric assessment of the specimen was performed. RESULTS: Surgical time was longer (144.8 vs. 202.5 min; p < 0.000) and postoperative stay shorter (8.0 vs. 10.5 days; p < 0.01) for the laparoscopic approach. The area of the resected mesentery (UFA, 15,097 mm(2); CON, 15,788 mm(2); p = 0.47) and the lymph node count (UFA, 59.0; CON, 51.0; p = 0.09) was not significantly different; additionally, no difference was observed regarding anastomotic leakage (both n = 0) and postoperative mortality (UFA, 0/28; CON, 1/51; p = 1.0). CONCLUSION: Laparoscopic right hemicolectomy with CME using the UFA provides adequate radicality according to the CME principles and seems feasible and as safe as an open technique. However, future trails will have to demonstrate whether the theoretical advantages of the UFA, with a higher degree of mobility and accessibility of the mesenteric root, translate into a significant clinical benefit, especially relative to the other laparoscopic techniques.
Entities:
Keywords:
CME; Colon cancer; Complete mesocolic excision; Laparoscopic hemicolectomy; Right hemicolectomy; Uncinate process first approach
Authors: F Rondelli; S Trastulli; N Avenia; G Schillaci; R Cirocchi; N Gullà; E Mariani; G Bistoni; G Noya Journal: Colorectal Dis Date: 2012-08 Impact factor: 3.788
Authors: Simone Sibio; A Di Giorgio; S D'Ugo; G Palmieri; L Cinelli; V Formica; B Sensi; G Bagaglini; S Di Carlo; V Bellato; G S Sica Journal: Langenbecks Arch Surg Date: 2019-11-23 Impact factor: 3.445
Authors: I Hamzaoglu; V Ozben; I Sapci; E Aytac; A Aghayeva; I A Bilgin; I E Bayraktar; B Baca; T Karahasanoglu Journal: Tech Coloproctol Date: 2018-08-06 Impact factor: 3.781
Authors: Bojan V Stimec; Bjarte T Andersen; Stefan R Benz; Jean H D Fasel; Knut M Augestad; Dejan Ignjatovic Journal: Int J Colorectal Dis Date: 2018-02-22 Impact factor: 2.571