Analysis of 20 patients with laparoscopic extended right colectomy

BACKGROUND Currently,the standard surgical procedure for right colon cancer is complete mesocolic excision.Whether preventive extended lymph node dissection for colon cancer located in the hepatic flexure or right transverse colon should be performed remains controversial because the safety and effectiveness of the operation have not been proven,and infrapyloric lymph nodes(No.206)and lymph nodes in the greater curvature of the stomach(No.204)have not been strictly defined and distinguished as surgical indicators in previous studies.AIM To analyze the metastatic status of infrapyloric lymph nodes and lymph nodes of the greater curvature of the stomach and perioperative complications and systematically evaluate the feasibility and safety of laparoscopic extended right colectomy using prospective data collected retrospectively.METHODS The study was a clinical study.Twenty patients with colon cancer who underwent laparoscopic extended right colon resection in our hospital from June 2020 to May 2021 were included.RESULTS Among the patients who underwent extended right colon resection,there were no intraoperative complications or conversion to laparotomy;2 patients had gastrocolic ligament lymph node metastasis,and 5 patients had postoperative complications.The patients with postoperative complications received conservative treatment.CONCLUSION Laparoscopic extended right colon resection is safe.However,malignant tumors located in the liver flexure or the right-side transverse colon are more likely to metastasize to the gastrocolic ligament lymph nodes,and notably,the incidence of gastroparesis was high.The number of patients was small,and the follow-up time was short.It is necessary to further increase the sample size to evaluate the No.204 and No.206 lymph node metastasis rates and the long-term survival impact.

What is the best surgical procedure of transverse colon cancer?An evidence map and minireview

Colorectal cancers comprise a large percentage of tumors worldwide,and transverse colon cancer(TCC)is defined as tumors located between hepatic and splenic flexures.Due to the anatomy and embryology complexity,and lack of large randomized controlled trials,it is a challenge to standardize TCC surgery.In this study,the current situation of transverse/extended colectomy,robotic/laparoscopic/open surgery and complete mesocolic excision(CME)concept in TCC operations is discussed and a heatmap is conducted to show the evidence level and gap.In summary,transverse colectomy challenges the dogma of traditional extended colectomy,with similar oncological and prognostic outcomes.Compared with conventional open resection,laparoscopic and robotic surgery plays a more important role in both transverse colectomy and extended colectomy.The CME concept may contribute to the radical resection of TCC and adequate harvested lymph nodes.According to published studies,laparoscopic or robotic transverse colectomy based on the CME concept was the appropriate surgical procedure for TCC patients.