Clinical efficacy of unidirectional-loop caudal-medial approach for laparoscopic-assisted radical resection of right colon cancer

Objective To investigate the clinical efficacy of unidirectional-loop caudal-medial approach for laparoscopic-assisted radical resection of right colon cancer. Methods The retrospective and descriptive study was performed. The clinical data of 37 patients who underwent laparoscopic-assisted radical resection of right colon cancer through unidirectional-loop caudal-medial approach at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2015 to March 2016 were collected. Tumor-free principle was followed and unidirectional-loop caudal-medial approach was conducted. Observation indicators included: (1) surgical situations: operation time, volume of intraoperative blood loss, (2) postoperative recovery: time to initial anal exsufflation, time of draining tube removal, postoperative complications, duration of postoperative hospital stay, (3) postoperative pathological examination: number of lymph node dissection, number of positive lymph node, length of specimen, incision margin, tumor pathological staging and type, (4) follow-up. All the patients were followed up using outpatient examination and telephone interview up to June 2016. Measurement data with normal distribution were presented as ±s and measurement data with skewed distribution were presented as average (range). Results (1) Surgical situations: 37 patients received successful operation, without conversion to open surgery and perioperative death. Operation time and volume of intraoperative blood loss in 37 patients were (170±50)minutes and 50 mL (range, 20-300 mL). (2) Postoperative recovery: time to initial anal exsufflation, time of draining tube removal and average duration of postoperative hospital stay were (3.5±1.0)days, (4.3±1.1) days and 10 days (range, 6-21 days), respectively. Two patients with postoperative wound liquefaction were improved by symptomatic treatment, and the other patients had no complication. (3) Postoperative pathological examination: number of lymph node dissection, number of positive lymph node, number of central lymph node dissection and length of specimen in 37 patients were 22±8, 0 (range, 0-6), 6±5 and (32±9)cm, respectively, with negative incision margins. Postoperative tumor pathological staging showed that stage pT1, pT2, pT3 and pT4a were detected in 0, 1, 33 and 3 patients, and stage pN0, pN1 and pN2 in 23, 12 and 2 patients, respectively. Postoperative tumor pathological type showed that 3, 7, 23 and 4 patients were respectively diagnosed with mucinous adenocarcinoma, high-differentiated adenocarcinoma, moderate-differentiated adeno-carcinoma and low-differentiated adenocar-cinoma. (4) Follow-up: 37 patients were followed up for 3-17 months with a median time of 11 months. During the follow-up, 1 patient was complicated with anastomotic recurrence and 4 with distant metastases, the other 32 patients had tumor-free survival. Conclusion Unidirectional-loop caudal-medial approach for laparoscopic-assisted radical resection of right colon cancer is safe and feasible, with a good short-term outcome, and it should be widely spread. Key words: Colonic neoplasms; Total mesocolic excision; Caudal-medial approach; Unidirectional-loop; Laparoscopy