The technical feasibility of laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer        FENG Bo, LU Ai-guo , WANG Ming-liang, et al. Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
Corresponding author:ZHENG Min-hua,E-mail: fengbo2022@163.com
Abstract    Objective    To investigate the feasibility and technical strategies of laparoscopic complete mesocolic excision (CME) for right-hemi colon cancer. Methods    The clinicopathological data of 35 cases with right-hemi colon cancer underwent laparoscopic CME between March 2010 and September 2011 in Ruijin Hospital, Shanghai Jiaotong University School of Medicine were analyzed retrospectively. The quality of surgery was assessed using the method reported by West and the surgical approaches, anatomic planes and technical tips were also elucidated by drawings and videos. Results    The mesocolon was covered by the visceral fascia from both sides like envelopes, which invoted the concept of CME as a technique with sharp dissection of the visceral plane from somatic one. The ileocolic vessel was served as a dissection trigger and dissection along superior mesenteric vessel and in the embryological plane formed by Told’s and prerenal fascia were the two key points in medial access. Central ligation of the supplying vessels was needed to obtain an increased lymph node removal. All the 35 cases were successfully performed laparoscopic CME and the 33 specimens were evaluated pathologically as mesocolic plane. The total number of lymph nodes removed was 15—25 and central lymph node metastasis was found in 5 cases of stage Ⅲ. The median operation time was 2.6 h and the blood loss was 80 mL. The median time for passage of flatus and hospitalization were 2d and 12d respectively. Complications were observed in 3 cases. Conclusion    CME is a novel concept for colon cancer and might be a standardization surgical procedure. Laparoscopic CME with medial access is technically feasible and randomized trials are needed to evaluate its long-term outcomes.