Laparoscopic right hemicolectomy – dissection before ligation

Published Date: 07th August 2018

Publication Authors: Cheung F, Kalaiselvan R, Samad A, Telfer R

​Aims

Laparoscopic right hemicolectomy (LRH) is the standard for removal of right-sided colon cancers. Commonly, vessel ligation occurs before mobilisation of the colon or lateral to medial dissection from the caecum. We describe the outcomes of an alternative method: mobilise from transverse colon so that retroperitoneal structures are visible before high ligation of the ileo-colic pedicle.

Method

Data was collected from a prospective database of all patients who underwent LRH for cancer between 01/02/2010 and 28/02/2010 and compared to open technique (ORH) with respect to length of stay (LOS) and lymph node (LN) yield. Mann-Whitney U test was used. p<0.05 was considered significant.

Results

130vs52 patients (58% male, age 70 (38-88) yrs. ASA2 (1-4)) underwent LRHvsORH. 9% required conversion. Average operating time was 176min. Median LOS following LRHvsORH was 5vs12 days (p<0.0001). Median LN yield was 20 for LRH and ORH (p=0.84). R0 resection was achieved in 95%. Post-operatively, 34 (26%) had complications (anastomotic leak N=1). 90-day survival was 98%. At median follow up of 50 (3-93) months, overall survival was 75%.

Conclusion

This technique is a relatively small adjustment to current UK practice and, for the experience surgeon, the outcomes are comparable. It does not compromise oncological or operative outcomes.

 

Cheung, FY; Telfer, R; Kalaiselvan, R; Samad, A. (2018). Laparoscopic right hemicolectomy – dissection before ligation. International Journal of Surgery. 55 (Suppl 1), S52

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