Short-term Outcome of Caudal to Cranial Approach in Radical Laparoscopic Right Hemicolectomy

In our study we evaluated the effectiveness of laparoscopic caudal to cranial approached access to the central vessels for CME with CVL in patients with right colon cancers depending on several factors including operative time, intra operative blood loss, hospital stay and oncological outcome including tumor free margins, harvested LNs and disease recurrence. We undertook a retrospective cohort study done of prospective maintained data of 24 patients undergoing laparoscopic colectomy for right colon cancer during the period from May 2019 to January 2022, at general surgery department of Zagazig University hospitals and Elsalam Oncology center. The data included patient age, diagnosis, duration of operation, operative blood loss, conversion to open, postoperative complications, length of hospital stay, mortality, and the duration of follow-up. During the study, there were 24 consecutive laparoscopic right hemicolectomies for right colon cancer performed. There were 24 patients (11 females, 13 males). The age range of presentation was (39-72). Tumor site in different parts of the right colon was distributed as follow 16.7 % in the caecum, 8.3 %in the caecum& ascending colon, 37.5% in ascending colon and 37.5% in the hepatic flexure and proximal transverse colon. 87.5% of cases were moderately differentiated adenocarcinoma and 12.5% poorly differentiated adenocarcinoma. In our study, complete mesocolic excision (CME) was achieved in 24 cases (100%). The average number of harvested lymph nodes was 17.9 +/- 6.5. Histological examination revealed that proximal and distal margins were free of tumor cells in all surgical specimens. The proximal and distal margins were > 5 cm in all specimens. The length of the ileocolic segment was 35.5 +/- 6.8 cm. Complete mesocolic excision with central vascular ligation is considered to contribute to superior oncological outcomes after colon cancer surgery. For advanced right-sided colon cancer, this surgery sometimes requires lymph node (LN) dissection along the superior mesenteric vein (SMV), with division of the middle colic vessels, or their right branches, at origin. Here, we present caudal to cranial approached radical LN dissection along the surgical trunk during laparoscopic right hemicolectomy.