Laparoscopic: Assisted Oncologic Right Hemicolectomy : Based on Vascular

Choi, Gyu Seog; Jun, Soo Han

Abstract

The aim of this study was to find out an effective method of laparoscopic oncologic right hemicolectomy based on vascular anatomy of the right colon and patterns of lymph node metastasis. From September 1994 to November 1997,20 hemodynamically stable patients received curative laparoscopic-assisted right hemicolectomy for adenocarcinoma by one surgeon. Simultaneously anatomic variations of right colonic vessels and patterns of lymph node metastasis were analyzed. All operations were performed by laparoscopic-assisted method that consisted of intracorporeal mobilization of the right colon followed by extracorporeal resection and anastomosis and lymph node dissection up to superior mesenteric vessels under direct vision through mini-incision just above the root of superior mesenteric vessels. Ileocolic (ICA) and mid colic artery (MCA) existed constantly (100%), right colic artery (RCA) existed only in 12 cases (60%). Mean distance from origin of MCA to ICA was 3.2cm. Mean number of lymph nodes harvested from SMA area was 2.9 per case. In 2 cases, they showed metastasis. Astler-Coilers stage Bl, B2, Cl, C2 were distributed in 6, 8, 1, 5 cases respectively. Mean number of lymph node dissected and length of resection margin was 29.3 and 8.7 cm. Operative time, time to oral intake, hospital stay was 187 minutes,2.6 days,7.2 days, respectively. Open conversion was needed in 1 case due to duodenal invasion. Mean 14 months follow-up showed 2 recurrences. One who have had duodenal wedge resection due to cancer invasion underwent reresection of duodenum because of duodenal recurrence 12 months after the first operation. The other suddenly died of myocardial infarction after operation for ovarian recurrence 8 months later to her right hemicolectomy. Right colonic vascular anatomy was so various but the area from MCA to ICA was constantly within 4 cm and, lymph nodes in that area must be cleared. Therefore, laparoscopic intracorporeal mobilization and extracorporeal resection of the right colon and lymph node dissection through small incision was effective, safe and one of the best method to get advantages of laparoscopic and open surgery simultaneously.