Laparoscopic extended right hemicolectomy with complete mesocolic excision and central vascular ligation for mid-transve
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Laparoscopic extended right hemicolectomy with complete mesocolic excision and central vascular ligation for mid‑transverse colon cancer F. Grama1,2 · A. Chitul1 · A. Ionica1 · E. Ciofic1 · I. Husar‑Sburlan3 · C. Bezede1 · D. Cristian1,2 Received: 17 May 2020 / Accepted: 14 June 2020 © Springer Nature Switzerland AG 2020
No consensus regarding the optimal procedure in transverse colon cancer has been reached; therefore, a variety of techniques have been proposed, including transversectomy, extended right colectomy or even subtotal colectomy. The possible lymphatic drainage of mid-colon tumors through both superior and inferior mesenteric vessels may impose the necessity of a more aggressive procedure to achieve a superior lymphadenectomy, thus leading to better overall and disease free survival rates [1]. Even if the transversectomy is considered a more conservative approach, it remains almost as aggressive as an extended right hemicolectomy since both comprise the mobilization of both colonic flexures and the dissection of the peripancreatic vessels. Moreover, a colocolic anastomosis may be more difficult and riskier than an ileocolic one; therefore, extended right hemicolectomy appears to be surgically safer [1]. On the other hand, other authors have reported similar oncological outcomes in extended right hemicolectomy versus transversectomy [2, 3]. There are some statistical limitations of the studies that focus on midtransvers cancers due to the variability of resected specimen extension, surgical technique or the type of the approach, which impede standardization [1–3]. Nevertheless, the common part and at the same time the most demanding one of these procedures, is the lymph node dissection surrounding the middle colic pedicle and also the venous anatomical variations in the vicinity of the pancreatic head [4]. A standard right hemicolectomy begins by entering the mesentery between the ileocolic and superior * A. Chitul [email protected] 1
General Surgery Department, Coltea Clinical Hospital, 1, I.C. Brătianu street, district 3, 030171 Bucharest, Romania
2
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
3
Gastroenterology Department, Laurus Medical Center, Bucharest, Romania
mesenteric vessels, and continues with the mobilization of the mesentery of the ascending colon [5]. In the attached video we illustrate our preference to start with splenic flexure mobilization along with inferior mesenteric vein ligation at the inferior border of the pancreas. Afterwards, the vein is divided again at the origin of the left colic artery, thus allowing us to mark, under direct vision, a safe distal margin for specimen transection. The left part of the transverse mesocolon is detached from the pancreatic surface near the left border of the middle colic pedicle. En bloc resection of the splenocolic and gastrocolic ligament with the greater omentum is performed due to the presence of suspect lymph nodes. Then the hepatic flexure is mobilized together with the righ
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