Techniques and feasibility of laparoscopic extended right hemicolectomy with D3 lymphadenectomy

AIM:To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy(LERH),according to our previous experience.METHODS:Anatomical relationship and operative techniques were demonstrated.One hundred and five consecutive patients who underwent extended right hemicolectomy with D3 lymphadenectomy between January 2008 and May 2011 were included in the present study[laparoscopic group(n=48)vs open group(n=57)].RESULTS:The right retrocolic space was the main surgical plan of the LERH.The superior mesenteric vein was the most important anatomical landmark for vascular dissection.The medial-to-lateral dissection approach made the LERH performed efficiently.Compared with the open group,the LERH group had less blood loss(111.7±127.8 mL vs 170.2±49.7 mL,P=0.023),faster return of flatus(3.0±1.6 d vs 3.7±1.3 d,P=0.019),and earlier diet(4.2±1.4 d vs 5.0±1.2 d,P=0.005).Five patients(10.4%)underwent conversion during laparoscopic surgery.The cancer recurrence rates between the two groups were comparable(laparoscopic vs open,8.6%vs 9.1%,P=0.335).CONCLUSION:For an advanced tumor located at the hepatic flexure or proximal transverse colon,LERH with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space severed as the surgical plan.