Techniques and Feasibility of the Caudal-to-Cranial Approach for Laparoscopic Right Colectomy With Complete Mesenteric Excision
Complete mesenteric excision (CME) is a novel concept for right colon cancer surgery. It derives from an embryological concept that the enveloped planes of viscera and fascia cover the lymphatic drainage and the mesentery. Research1–5 has shown that CME is a feasible and safe procedure and can reduce the rate of local recurrence and improve long-term survival in open surgeries. Recently, a consensus statement6 has stated that CME is as equally well suited for an open right colectomy as a laparoscopic right colectomy. However, laparoscopic right radical colectomy with CME is technically challenging because the procedure involves many organs and complex anatomical structures.7 Therefore, it is necessary to develop an approach to reduce the procedural complexity and difficulty for advanced right colon cancer. Based on our more than 2000 previous laparoscopic surgeries for colon cancer and our understanding of surgical oncology and the anatomical structures of the right mesocolon, we present a caudal-to-cranial approach for laparoscopic right colectomy with CME.