Laparoscopic complete mesocolic excision with true central vascular ligation for right-sided colon cancer
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Laparoscopic complete mesocolic excision with true central vascular ligation for right‑sided colon cancer Masanobu Enomoto1 · Kenji Katsumata1 · Kenta Kasahara1 · Tomoya Tago1 · Naoto Okazaki1 · Takahiro Wada1 · Hiroshi Kuwabara1 · Junichi Mazaki1 · Tetsuo Ishizaki1 · Yuichi Nagakawa1 · Akihiko Tsuchida1 Received: 9 May 2020 / Accepted: 5 August 2020 © The Author(s) 2020
Abstract Background Complete mesocolic excision (CME) is known to be effective for colon cancer. However, in right-sided colon cancer, central vascular ligation (CVL) is not easy to perform. In particular, in patients in whom the superior mesenteric vein (SMV) runs on the ventral side of the superior mesenteric artery (SMA) (Type V/A), laparoscopic ligation of the artery at its root is extremely difficult compared with this procedure in patients in whom the SMA runs on the ventral side of the SMV (Type A/V). Methods We started performing laparoscopic CME with true CVL for right-sided colon cancer using the SMA as a landmark in 2015, and by 2019, we had completed it for 60 patients. To start, the mesocolon is opened well to the caudal side of the ileocolic vessels. The mesentery is then fully detached from the retroperitoneal tissue, after which the ileocolic vessels are ligated at their roots. D3 lymph node dissection of the lymph nodes around the SMA and SMV on the resection side is also performed using the SMA as a landmark, and depending on the location of the tumor, the roots of the right and middle colic vessels are ligated and divided. This study was conducted with the approval of the Tokyo Medical University Ethics Committee. All patients provided informed consent. Results The tumor was located in the cecum in 21 cases, the ascending colon in 33, and the transverse colon in 6. The mean operating time was 229 min and the mean volume of hemorrhage was 67 ml. There was one Clavien-Dindo Grade 3 or worse postoperative complication (ileus). There were no surgery-related or in-hospital deaths. Conclusion This procedure can be performed comparatively safely. However, since it requires some skill, we consider that it should only be performed in suitable cases by teams with sufficient experience. Keywords Complete mesocolic excision · D3 lymph node dissection · Laparoscopy · Colon cancer · Right hemicolectomy The effectiveness of complete mesocolic excision (CME) for colon cancer is commonly known [1, 2]. CME is generally performed with the aim of separating the mesocolon from the parietal plane to allow true central ligation of the supplying arteries and draining veins at their roots [1]. However, in right-sided colon cancer, the courses of the vessels concerned are complex, and central vascular ligation (CVL) is Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07867-z) contains supplementary material, which is available to authorized users. * Masanobu Enomoto enomoto@tokyo‑med.ac.jp 1
Department of Gastrointestinal and Pe
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