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Zhang M, Ye C, Huang R, Zou Z. Laparoscopic complete right hemicolectomy: Surgical trunk-oriented adjuvant radical surgery for right hemicolonic carcinoma-A video vignette. Colorectal Dis 2024; 26:1461-1462. [PMID: 38644650 DOI: 10.1111/codi.16987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/16/2024] [Accepted: 02/03/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Minglin Zhang
- Department of General Surgery, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Chun Ye
- Department of General Surgery, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Renli Huang
- Department of General Surgery, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhaowei Zou
- Department of General Surgery, Zhujiang Hospital, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Ogi Y, Sugishita H, Akita S, Ishimaru K, Koga S, Yoshida M, Kikuchi S, Kuwabara J, Matsumoto H, Goyo K, Kashu N, Watanabe K, Habu K, Takagi K, Oshikiri T. A case of robot-assisted resection for cecum cancer with anomalous venous confluence. Asian J Endosc Surg 2024; 17:e13313. [PMID: 38631698 DOI: 10.1111/ases.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
There are many reports on the positional relationship between the ileocolic artery and superior mesenteric vein (SMV). However, there have been no reports of anomalous venous confluence in the ileocecal vessel area. A 69-year-old man was diagnosed with cecal cancer on a preoperative examination of a lung tumor. We planned to perform surgery for the cecal cancer. Computed tomography angiography revealed an anomalous vein confluence in the ileocolic region. We performed robot-assisted ileocecal resection. Although the small intestinal vein was misidentified as the SMV at first, we confirmed the misidentification, identified the SMV on the dorsal side of the ileocolic artery, and ligated the ileocolic vessels with precise forceps manipulation during robotic surgery. Especially for cases with vascular anomalies revealed by preoperative computed tomography angiography, robotic surgery may be useful, as flexible forceps manipulation prevents vascular injury.
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Affiliation(s)
- Yusuke Ogi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Hiroki Sugishita
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Satoshi Akita
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Kei Ishimaru
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Shigehiro Koga
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Motohira Yoshida
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Satoshi Kikuchi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Jun Kuwabara
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Hironori Matsumoto
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Kai Goyo
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Noriaki Kashu
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Katsuya Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Kyousuke Habu
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Kenji Takagi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
| | - Taro Oshikiri
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Japan
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Yang SY, Kim MJ, Kye BH, Han YD, Cho MS, Park JW, Jeong SY, Song SH, Park JS, Park SY, Kim J, Min BS. Surgical quality assessment for the prospective study of oncologic outcomes after laparoscopic modified complete mesocolic excision for nonmetastatic right colon cancer (PIONEER study). Int J Surg 2024; 110:1484-1492. [PMID: 38484260 PMCID: PMC10942238 DOI: 10.1097/js9.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/20/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND The modified complete mesocolic excision (mCME) procedure for right-sided colon cancer is a tailored approach based on the original complete mesocolic excision (CME) methodology. Limited studies evaluated the safety and feasibility of laparoscopic mCME using objective surgical quality assessments in patients with right colon cancer. The objectives of the PIONEER study were to evaluate oncologic outcomes after laparoscopic mCME and to identify optimal clinically relevant endpoints and values for standardizing laparoscopic right colon cancer surgery based on short-term outcomes of procedures performed by expert laparoscopic surgeons. MATERIALS AND METHODS This is an ongoing prospective, multi-institutional, single-arm study conducted at five tertiary colorectal cancer centers in South Korea. Study registrants included 250 patients scheduled for laparoscopic mCME with right-sided colon adenocarcinoma (from the appendix to the proximal half of the transverse colon). The primary endpoint was 3-year disease-free survival. Secondary outcomes included 3-year overall survival, incidence of morbidity in the first 4 weeks postoperatively, completeness of mCME, central radicality, and distribution of metastatic lymph nodes. Survival data will be available after the final follow-up date (June 2024). RESULTS The postoperative complication rate was 12.9%, with a major complication rate of 2.7%. In 87% of patients, central radicality was achieved with dissection at or beyond the level of complete exposure of the superior mesenteric vein. Mesocolic plane resection with an intact mesocolon was achieved in 75.9% of patients, as assessed through photographs. Metastatic lymph node distribution varied by tumor location and extent. Seven optimal clinically relevant endpoints and values were identified based on the analysis of complications in low-risk patients. CONCLUSIONS Laparoscopic mCME for right-sided colon cancer produced favorable short-term postoperative outcomes. The identified optimal clinically relevant endpoints and values can serve as a reference for evaluating surgical performance of this procedure.
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Affiliation(s)
- Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine
| | - Bong-Hyeon Kye
- Department of Surgery, Catholic University of Korea School of Medicine
| | - Yoon Dae Han
- Department of Surgery, Yonsei University College of Medicine
| | - Min Soo Cho
- Department of Surgery, Yonsei University College of Medicine
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine
| | - Seung Ho Song
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jun Seok Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Soo Yeun Park
- Department of Surgery, Korea University College of Medicine, Seoul
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine
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Grüter AA, Sijmons JM, Coblijn UK, Toorenvliet BR, Tanis PJ, Tuynman JB. Best Evidence for Each Surgical Step in Minimally Invasive Right Hemicolectomy: A Systematic Review. ANNALS OF SURGERY OPEN 2023; 4:e343. [PMID: 38144490 PMCID: PMC10735091 DOI: 10.1097/as9.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The aim of this study was to systematically review the literature for each surgical step of the minimally invasive right hemicolectomy (MIRH) for non-locally advanced colon cancer, to define the most optimal procedure with the highest level of evidence. Background High variability exists in the way MIRH is performed between surgeons and hospitals, which could affect patients' postoperative and oncological outcomes. Methods A systematic search using PubMed was performed to first identify systematic reviews and meta-analyses, and if there were none then landmark papers and consensus statements were systematically searched for each key step of MIRH. Systematic reviews were assessed using the AMSTAR-2 tool, and selection was based on highest quality followed by year of publication. Results Low (less than 12 mmHg) intra-abdominal pressure (IAP) gives higher mean quality of recovery compared to standard IAP. Complete mesocolic excision (CME) is associated with lowest recurrence and highest 5-year overall survival rates, without worsening short-term outcomes. Routine D3 versus D2 lymphadenectomy showed higher LN yield, but more vascular injuries, and no difference in overall and disease-free survival. Intracorporeal anastomosis is associated with better intra- and postoperative outcomes. The Pfannenstiel incision gives the lowest chance of incisional hernias compared to all other extraction sites. Conclusion According to the best available evidence, the most optimal MIRH for colon cancer without clinically involved D3 nodes entails at least low IAP, CME with D2 lymphadenectomy, an intracorporeal anastomosis and specimen extraction through a Pfannenstiel incision.
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Affiliation(s)
- Alexander A.J. Grüter
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Julie M.L. Sijmons
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Usha K. Coblijn
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Pieter J. Tanis
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Jurriaan B. Tuynman
- From the Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Landolsi S, Youssfi R, Trabelsi M, Touati D, Saidi A, Chebbi F. Exceptional vascular variants during oncological right colectomy: Case reports. Int J Surg Case Rep 2023; 111:108853. [PMID: 37742356 PMCID: PMC10520797 DOI: 10.1016/j.ijscr.2023.108853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/16/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Carcinological right colectomy with complete D3 mesocolon excision has to be guided by vascular variants in order to avoid complications especially in exceptional cases as illustrated by our two cases. CASE PRESENTATIONS Two women had right colectomies with compete D3 mesocolon excision via laparotomy for right colon tumors with a non-modal anatomy: an X-shaped relationship between the superior mesenteric artery and the superior mesenteric vein and a Y-shaped superior mesenteric vein, an ileocolic artery behind the two trunks, a right colic artery behind the left trunk, and the middle colic artery anterior to the main trunk of the superior mesenteric vein respectively. DISCUSSION Our cases illustrated extremely rare vascular variants during right colectomy with complete mesocolic excision. These variants should be identified based on the computed tomography with coronal reconstructions allowing to guide surgical procedure before the operating room in order to anticipate per-operative difficulties and reduce morbidity. CONCLUSIONS Vascular anatomical study based on computed tomography with coronal reconstructions was mandatory before right colectomy with complete mesocolic excision and D3 lymphadenectomy.
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Affiliation(s)
- Sana Landolsi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia.
| | - Rahma Youssfi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Mehdi Trabelsi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Dhaker Touati
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Aymen Saidi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Faouzi Chebbi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
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Yu A, Li Y, Zhang H, Hu G, Zhao Y, Guo J, Wei M, Yu W, Yan Z. Development and validation of a preoperative nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer: a retrospective analysis. Int J Surg 2023; 109:870-878. [PMID: 36999773 PMCID: PMC10389525 DOI: 10.1097/js9.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/09/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND In laparoscopic right hemicolectomy for right colon cancer, complete mesocolic excision is a standard procedure that involves extended lymphadenectomy and blood vessel ligation. This study aimed to establish a nomogram to facilitate evaluation of the surgical difficulty of laparoscopic right hemicolectomy based on preoperative parameters. MATERIALS AND METHODS The preoperative clinical and computed tomography-related parameters, operative details, and postoperative outcomes were analyzed. The difficulty of laparoscopic colectomy was defined using the scoring grade reported by Escal et al . with modifications. Multivariable logistic analysis was performed to identify parameters that increased the surgical difficulty. A preoperative nomogram to predict the surgical difficulty was established and validated. RESULTS A total of 418 consecutive patients with right colon cancer who underwent laparoscopic radical resection at a single tertiary medical center between January 2016 and May 2022 were retrospectively enrolled. The patients were randomly assigned to a training data set ( n =300, 71.8%) and an internal validation data set ( n =118, 28.2%). Meanwhile, an external validation data set with 150 consecutive eligible patients from another tertiary medical center was collected. In the training data set, 222 patients (74.0%) comprised the non-difficulty group and 78 (26.0%) comprised the difficulty group. Multivariable analysis demonstrated that adipose thickness at the ileocolic vessel drainage area, adipose area at the ileocolic vessel drainage area, adipose density at the ileocolic vessel drainage area, presence of the right colonic artery, presence of type III Henle's trunk, intra-abdominal adipose area, plasma triglyceride concentration, and tumor diameter at least 5 cm were independent risk factors for surgical difficulty; these factors were included in the nomogram. The nomogram incorporating seven independent predictors showed a high C-index of 0.922 and considerable reliability, accuracy, and net clinical benefit. CONCLUSIONS The study established and validated a reliable nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer. The nomogram may assist surgeons in preoperatively evaluating risk and selecting appropriate patients.
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Affiliation(s)
- Ao Yu
- Department of General Surgery
| | | | - Haifeng Zhang
- Department of General Surgery, Linyi People’s Hospital, Linyi, People’s Republic of China
| | - Guanbo Hu
- Shandong Healthcare Industry Development Group Co. Ltd., Shandong Healthcare, Zaozhuang
| | - Yuetang Zhao
- Department of General Surgery, Yutai County People’s Hospital, Jining
| | - Jinghao Guo
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan
| | - Meng Wei
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan
| | - Wenbin Yu
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan
| | - Zhibo Yan
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan
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Wang Z, Li L, Dong S, Li M, Tan A, Kou Z, Liang R. Frequencies and Injury Analysis of Small Anterior Branch of Gastrocolic Trunk. J Laparoendosc Adv Surg Tech A 2023; 33:52-55. [PMID: 35856874 DOI: 10.1089/lap.2022.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective: Small anterior branch of gastrocolic trunk (SABGT) can be occasionally observed during transverse colectomy and right hemicolectomy. Improperly dealing with the branch may lead to unwanted bleeding and affect the operation process. The purposes of this study are to analyze the frequencies and injury of SABGT. Methods: Intact operation data were collected retrospectively from 39 colon cancer patients who underwent curative laparoscopic transverse colectomy or right hemicolectomy. Frequencies and injury of SABGT were analyzed. Results: Eight cases had SABGT, the frequencies of which is 20.5%. Injury of SABGT occurred intraoperatively in 2 patients. Conclusion: We suggest that SABGT should be considered in surgical management. Consciously looking for and properly dealing with the branch can minimize the influence on the operation process.
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Affiliation(s)
- Zhiqiang Wang
- Department of Anorectal Surgery, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Leilei Li
- Department of Pathology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shuai Dong
- Department of Anorectal Surgery, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Menglong Li
- Department of Anorectal Surgery, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ailin Tan
- Department of Anorectal Surgery, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhiyong Kou
- Department of Oncology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Rui Liang
- Department of Pathology, the Second Hospital of Tianjin Medical University, Tianjin, China
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Value of different anastomoses in laparoscopic radical right hemicolectomy for right-sided colon cancer: retrospective study and literature review. World J Surg Oncol 2022; 20:318. [PMID: 36171623 PMCID: PMC9520856 DOI: 10.1186/s12957-022-02789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/21/2022] [Indexed: 01/19/2023] Open
Abstract
Background This study aimed to analyze the safety of circular lateral anastomosis and cross-lateral anastomosis in laparoscopic radical resection of right-sided colon cancer. Methods From January 2018 to March 2021, 147 patients with right-sided colon cancer were admitted to the Department of General Surgery, Cancer Hospital, Zhengzhou University. The experimental group comprised patients with circular lateral anastomosis, whereas the control group comprised patients with cruciform lateral anastomosis. The general clinical data, intraoperative features, and postoperative results of the two groups were compared and analyzed. Results Both groups successfully underwent laparoscopic lateral ileocolic anastomosis, with significant differences in anastomotic leakage (χ2=4.520, P < 0.05). By contrast, body mass index (t = 1.568, P = 0.119), histological typing (χ2 = 2.067, P = 0.559), intraoperative bleeding (t = 0.418, P = 0.677), and intestinal obstruction (χ2 = 2.564, P = 0.109) were not significantly different between the groups (P > 0.05). Conclusions In laparoscopic-assisted radical hemicolectomy for right-sided colon cancer, the incidence of postoperative anastomotic leakage was lower with circular lateral anastomosis than with cross-lateral anastomosis, and circular lateral anastomosis was superior to cross-lateral anastomosis in terms of reducing the length of hospital stay and improving patients' postoperative quality of life.
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Coco D, Leanza S. Vascular Anatomy and Variants: Knowledge during Laparoscopic Right Colectomy. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
From the review of the literature and clinical data, it is clear that the anatomy of the vessels of the right colon is remarkably variable, especially those of Henle branch. This justifies why the laparoscopic colectomy (LRC) plus complete mesocolon excision (CME) is often difficult to perform with the conversion rate due to the lesion of the vessels. The objective of this study was to retrospectively review the videos and literature of the right laparoscopic colectomy plus CME to highlight the greatest number of vascular variations of the right colon, to record them, and to highlight the methods by which cope with these variations during surgery.
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Mizumoto R, Tei M, Mori S, Nishida K, Yasuyama A, Nomura M, Yoshikawa Y, Sueda T, Matsumura T, Koga C, Miyagaki H, Tsujie M, Akamaru Y. A case in which the ileocolic vein draining into the gastrocolic trunk of Henle could be diagnosed preoperatively: a rare anatomical case report. Surg Case Rep 2022; 8:110. [PMID: 35666402 PMCID: PMC9170846 DOI: 10.1186/s40792-022-01462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Numerous variations in vascular anatomy have been reported in the right colon. The ileocolic vein (ICV) generally drains directly into the superior mesenteric vein (SMV), and is an important landmark for laparoscopic surgery in right colon cancer. We present here a patient with a vascular anomaly of the ICV that was diagnosed on preoperative imaging. Case presentation A 65-year-old woman was diagnosed with transverse colon cancer by colonoscopy. Preoperative computed tomography scan showed that the ICV drained into the gastrocolic trunk of Henle (GCT) rather than the SMV. Single-incision laparoscopic transverse colectomy with D3 lymph node dissection was performed, dividing the middle colic vein (MCV) and preserving the right gastroepiploic vein (RGEV), anterior superior pancreaticoduodenal vein (ASPDV), GCT and ICV. The intraoperatively identified venous anatomy was consistent with the preoperative evaluation, and the RGEV, ASPDV and ICV were found to form the GCT. Conclusion We report a rare vascular anatomical anomaly that was diagnosed preoperatively, facilitating safe and successful single-incision laparoscopic surgery with D3 lymph node dissection.
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Affiliation(s)
- Rie Mizumoto
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan.
| | - Soichiro Mori
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Kentaro Nishida
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Akinobu Yasuyama
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Masatoshi Nomura
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Yukihiro Yoshikawa
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Toshinori Sueda
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Tae Matsumura
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Chikato Koga
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Hiromichi Miyagaki
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Masanori Tsujie
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
| | - Yusuke Akamaru
- Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonechō, Kita-ku, Sakai, Ōsaka-fu, 591-8025, Japan
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Cirocchi R, Randolph J, Davies RJ, Cheruiyot I, Gioia S, Henry BM, Carlini L, Donini A, Anania G. A systematic review and meta-analysis of variants of the branches of the superior mesenteric artery: the Achilles heel of right hemicolectomy with complete mesocolic excision? Colorectal Dis 2021; 23:2834-2845. [PMID: 34358401 DOI: 10.1111/codi.15861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022]
Abstract
AIM Dissection with subsequent ligation and resection of arteries at their origin (central vascular ligation) is essential for adequate oncological resection during right hemicolectomy with complete mesocolic excision. This technique is technically demanding due to the highly variable arterial pattern of the right colon. Therefore, this study aims to provide a comprehensive evidence-based assessment of the arterial vascular anatomy of the right colon. METHODS A thorough systematic literature search through September 2020 was conducted on the electronic databases PubMed, Scopus and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using MetaXl software. RESULTS A total of 41 studies (n = 4691 patients) were included. The ileocolic artery (ICA), right colic artery (RCA) and middle colic artery (MCA) were present in 99.7% (95% CI 99.4%-99.8%), 72.6% (95% CI 61.3%-82.5%) and 96.9% (95% CI 94.2%-98.8%) respectively of patients. Supernumerary RCA and MCA were observed in 3.2% and 11.4% respectively of all cases. The RCA shared a common trunk with the ICA and MCA in 13.2% and 17.7% respectively of patients. A retro-superior mesenteric vein course of the ICA and RCA was observed in 55.1% and 11.4% respectively of all cases. CONCLUSION The vascular anatomy of the right colon displays several notable variations, namely the absence of some branches (RCA absent in 27.4% of cases), supernumerary branches, common trunks, and retro-superior mesenteric vein courses. These variations should be taken into consideration during right hemicolectomy with complete mesocolic excision to ensure adequate oncological resection while minimizing intra-operative complications.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Sara Gioia
- School of Medicine, Perugia, 3 Section of Legal Medicine, Hospital of Terni, University of Perugia, Terni, Italy
| | | | - Luigi Carlini
- School of Medicine, Perugia, 3 Section of Legal Medicine, Hospital of Terni, University of Perugia, Terni, Italy
| | - Annibale Donini
- Department of Surgical Science, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Gabriele Anania
- Department of Medical Science, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
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Abbey E, Yang F, Qi L, Wu JJ, Tong L, Zhen Z. Situs inversus totalis patients with gastric cancer: Robotic surgery the standard of treatment?-A case report. Int J Surg Case Rep 2021; 81:105818. [PMID: 33887833 PMCID: PMC8050025 DOI: 10.1016/j.ijscr.2021.105818] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/27/2022] Open
Abstract
Situs inversus totalis is a very rare congenital anomaly. Variant anatomy will inevitably conflict with surgical habits. Minimally invasive surgery for situs inversus totalis patients has more advantages over traditional surgery.
Introduction and importance Situs inversus totalis (SIT) is a very rare congenital condition. Situs inversus totalis (SIT) patients who present with gastric cancer have been reported in Japan, China, the United States, and other countries. China has a high incidence of gastric cancer, accounting for 40% of the global annual incidence. Surgical treatment options for situs inversus totalis (SIT) gastric cancer patients are of great concern due to the rare nature of the condition and the anatomical variations. This case aims to demonstrate the utility of robotic surgery in treating situs inversus totalis patients with gastric cancer. Case presentation We report a 69-year-old male situs inversus totalis (SIT) gastric cancer patient who successfully underwent a DaVinci robotic-assisted distal gastrectomy with Roux-en-Y reconstruction. The patient had no complications after the operation and was discharged postoperative day 15. Clinical discussion Gastric cancer is an aggressive disease that requires timely diagnosis and appropriate intervention. Unfortunately, many patients present late with gastric cancer and do not benefit from surgical or other appropriate interventions. Patients who are eligible for surgery however still need a clean marginal resection to maximize prognosis, which is not always possible due to complex anatomy or variations as seen in situs inversus totalis. DaVinci robotic surgery system is a new generation of minimally invasive operating systems after conventional laparoscopy, and its visual field clarity, operating flexibility, and instrument stability have obvious advantages over conventional laparoscopic surgery and traditional open surgery. Conclusion Robotic surgery for situs inversus totalis (SIT) patients is more advantageous than laparoscopic and traditional surgeries as it offers a broader view of the variant anatomy and allows optimum dexterity and clarity.
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Affiliation(s)
- Eugene Abbey
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fu Yang
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Liu Qi
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jiang Jian Wu
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Li Tong
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhang Zhen
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Wilhelm D, Vogel T, Neumann PA, Friess H, Kranzfelder M. Complete mesocolic excision in minimally invasive surgery of colonic cancer: do we need the robot? Eur Surg 2020. [DOI: 10.1007/s10353-020-00677-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Summary
Background
Robotic surgery offers favorable prerequisites for complex minimally invasive surgeries which are delivered by higher degrees of freedom, improved instrument stability, and a perfect visualization in 3D which is fully surgeon controlled. In this article we aim to assess its impact on complete mesocolic excision (CME) in colon cancer and to answer the question of whether the current evidence expresses a need for robotic surgery for this indication.
Methods
Retrospective analysis and review of the current literature on complete mesocolic excision for colon cancer comparing the outcome after open, laparoscopic, and robotic approaches.
Results
Complete mesocolic excision results in improved disease-free survival and reduced local recurrence, but turns out to be complex and prone to complications. Introduced in open surgery, the transfer to minimally invasive surgery resulted in comparable results, however, with high conversion rates. In comparison, robotic surgery shows a reduced conversion rate and a tendency toward higher lymph node yield. Data, however, are insufficient and no high-quality studies have been published to date. Almost no oncologic follow-up data are available in the literature.
Conclusion
The current data do not allow for a reliable conclusion on the need of robotic surgery for CME, but show results which hypothesize an equivalence if not superiority to laparoscopy. Due to recently published technical improvements for robotic CME and supplementary features of this method, we suppose that this approach will gain in importance in the future.
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Ow ZGW, Sim W, Nistala KRY, Ng CH, Koh FHX, Wong NW, Foo FJ, Tan KK, Chong CS. Comparing complete mesocolic excision versus conventional colectomy for colon cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2020; 47:732-737. [PMID: 32951936 DOI: 10.1016/j.ejso.2020.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/26/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022] Open
Abstract
Conventional colectomy, and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) D2 Lymphadenectomy (LND2), are currently considered standard of care for surgical management of colon cancer. Colectomy with complete mesocolic excision (CME) and JSCCR D3 Lymphadenectomy (LND3) are more radical alternative approaches and provide a greater degree of lymph nodal clearance. However, controversy exists over the long-term benefits of CME/LND3 over non-CME colectomies (NCME)/LND2. In this study, we performed a systematic review and meta-analysis to compare the surgical, pathological, and oncological outcomes of CME/LND3 with NCME/LND2. Embase, Medline and CENTRAL databases were searched from inception until May 15, 2020, in accordance with PRISMA guidelines. Studies were included if they compared curative intent CME/LND3 with NCME/LND2. Weighted mean differences (WMD) and odds ratios (OR) were estimated for continuous and dichotomous outcomes respectively. Out of 1310 unique citations, 106 underwent full-text review, and 30 were included for analysis. In total, 21,695 patients underwent resection for colon cancer. 11,625 received CME/LND3, and 10,070 underwent NCME/LND2. No significant differences were found in post-operative morbidity and mortality. Both overall and disease-free survival favored CME/LND3 (5-year OS: OR = 1.29; 95% CI 1.02 to 1.64, p = 0.03; 5-year DFS: OR = 1.61; 95% CI 1.14 to 2.28; p = 0.007). This is the first systematic review and meta-analysis to demonstrate that CME/LND3 has superior long-term survival outcomes compared to NCME/LND2.
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Affiliation(s)
| | - Wilson Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Neng Wei Wong
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore.
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Matsuda T, Yamashita K, Hasegawa H, Utsumi M, Kakeji Y. Current status and trend of laparoscopic right hemicolectomy for colon cancer. Ann Gastroenterol Surg 2020; 4:521-527. [PMID: 33005847 PMCID: PMC7511568 DOI: 10.1002/ags3.12373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 01/19/2023] Open
Abstract
Laparoscopic right hemicolectomy (LRH) is utilized worldwide as one of the standard surgical treatments for right-sided colon cancer. However, there have been issues concerning its applicability, techniques, and trend. The present study aimed to elucidate the current status and trend of LRH by reviewing literature focusing on important issues associated with this surgery. Based on previous studies, LRH most likely provides better short-term outcomes and similar oncological outcomes compared to open surgery. Despite the increasing use of robotic approach in this surgery, it seems to have always been associated with longer operative times and greater hospital cost with limited advantage. Intracorporeal anastomosis seems to improve short-term outcomes, such as quicker recovery of bowel function, compared to extracorporeal anastomosis. However, it does not contribute to shorter hospital stay. With regard to dissection technique, various approaches, and landmarks have been advocated to overcome the technical difficulty in LRH. This difficulty is likely to be caused by anatomical variation, especially in venous structures. The superiority of one approach or landmark over another is still argued about due to the lack of large-scale prospective studies. However, deep understanding both of anatomical variation and characteristics of each approach would be of extreme importance to minimize adverse effects and maximize patient benefit after LRH.
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Affiliation(s)
- Takeru Matsuda
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
- Division of Minimally Invasive SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Kimihiro Yamashita
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Masako Utsumi
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
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Yang SY, Kim MJ, Kye BH, Han YD, Cho MS, Jeong SY, Cho HM, Kim H, Kang GH, Song SH, Park JS, Kim JS, Park SY, Kim J, Min BS. Prospective study of oncologic outcomes after laparoscopic modified complete mesocolic excision for non-metastatic right colon cancer (PIONEER study): study protocol of a multicentre single-arm trial. BMC Cancer 2020; 20:657. [PMID: 32664881 PMCID: PMC7362526 DOI: 10.1186/s12885-020-07151-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background The introduction of complete mesocolic excision (CME) with central vascular ligation (CVL) for right-sided colon cancer has improved the oncologic outcomes. Recently, we have introduced a modified CME (mCME) procedure that keeps the same principles as the originally described CME but with a more tailored approach. Some retrospective studies have reported the favourable oncologic outcomes of laparoscopic mCME for right-sided colon cancer; however, no prospective multicentre study has yet been conducted. Methods This study is a multi-institutional, prospective, single-arm study evaluating the oncologic outcomes of laparoscopic mCME for adenocarcinoma arising from the right side of the colon. A total of 250 patients will be recruited from five tertiary referral centres in South Korea. The primary outcome of this study is 3-year disease-free survival. Secondary outcome measures include 3-year overall survival, incidence of surgical complications, completeness of mCME, and distribution of metastatic lymph nodes. The quality of laparoscopic mCME will be assessed on the basis of photographs of the surgical specimen and the operation field after the completion of lymph node dissection. Discussion This is a prospective multicentre study to evaluate the oncologic outcomes of laparoscopic mCME for right-sided colon cancer. To the best of our knowledge, this will be the first study to prospectively and objectively assess the quality of laparoscopic mCME. The results will provide more evidence about oncologic outcomes with respect to the quality of laparoscopic mCME in right-sided colon cancer. Trial registration ClinicalTrials.gov ID: NCT03992599 (June 20, 2019). The posted information will be updated as needed to reflect protocol amendments and study progress.
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Affiliation(s)
- Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro, Seodaemun-ku, Seoul, 120-752, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Bong-Hyeon Kye
- Department of Surgery, Catholic University of Korea School of Medicine, Seoul, South Korea
| | - Yoon Dae Han
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro, Seodaemun-ku, Seoul, 120-752, South Korea
| | - Min Soo Cho
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro, Seodaemun-ku, Seoul, 120-752, South Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon-Min Cho
- Department of Surgery, Catholic University of Korea School of Medicine, Seoul, South Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
| | - Gyeong Hoon Kang
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Ho Song
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jun Seok Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ji-Seon Kim
- Department of Surgery, Korea University College of Medicine, 73 Goryeodae-ro, Seoul, South Korea
| | - Soo Yeun Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea.
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, 73 Goryeodae-ro, Seoul, South Korea.
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro, Seodaemun-ku, Seoul, 120-752, South Korea.
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