Clinical efficacy of laparoscopic right hemicolectomy via limited medial approach / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinical efficacy of laparoscopic fight hemicolectomy via limited medial approach.Methods The retrospective and descriptive study was conducted.The clinical data of 32 patients [15 males and 17 females,average age 62 years (range,49-70 years] with right colon cancer who were admitted to the Tianjin Medical University Cancer Hospital between July 2016 and April 2018 were collected.All the patients underwent laparoscopic right hemicolectomy via cranial-caudal-medial approach followed no-touch isolation technique.Observation indicators(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up situations.Follow-up using outpatient examination and telephone interview to detect postoperative survival of patients and tumor metastasis or recurrence up to May 2018.Measurement data were represented as average (range).Results (1) Surgical and postoperative recovery situations32 patients underwent successfully laparoscopic right hemicolectomy via limited medial approach,without conversion to open surgery and perioperative death.The operation time,volume of intraoperative blood loss,time to initial anal exsufflation,time for fluid diet intake and duration of postoperative hospital stay were 180 minutes (range,150-260 minutes),100 mL (range,50-350 mL),3 days (range,2-6 days),4 days (range,3-7 days) and 12 days (range,10-22 days),respectively.Of 3 with postoperative complications in the 32 patients,1 with paralytic ileus,1 with wound infection and 1 with diarrhea were improved by symptomatic treatment.(2) Postoperative pathological examinationthe number of dissected lymph nodes,number of dissected central lymph nodes and length of surgical specimen were 28 (range,19-43),8 (range,6-12) and 30 cm (range,25-39 cm),respectively,with negative incision margins.Postoperative tumor pathological staging showed that stage pTl,pT2,pT3 and pT4a were detected in 2,8,19 and 3 patients,and stage pN0,pN1 and pN2 in 16,12 and 4 patients,respectively.Postoperative tumor pathological typing showed that 3,7,18 and 4 patients were respectively diagnosed with mucinous adenocarcinoma,high differentiated adenocarcinoma,moderate differentiated adenocarcinoma and low differentiated adenocarcinoma.(3) Follow-up situations32 patients were followed-up for 1-22 months,with an average time of 11 months.During the follow-up,6 patients were complicated with distant metastasis and the others had disease-free survival.Conclusion Laparoscopic right hemicolectomy via limited medial approach is safe and feasible,with a good short-term outcome.