Clinical comparative study of the modified superior mesenteric artery approach in total laparoscopic radical resection for right colon cancer - a single-center retrospective study.

Abstract

Background: To explore the safety and feasibility of the modified approach for accessing the superior mesenteric artery (SMA) in total laparoscopic radical resection for right colon cancer.

Methods: This single-center retrospective study included 107 patients who underwent total laparoscopic radical resection of right colon cancer at The First Affiliated Hospital of Wannan Medical College between August 2022 and December 2023. 53 patients were in the modified SMA approach (modified group) and 54 patients were in the traditional SMA approach (control group). The control group and modified group underwent total laparoscopic radical resection of right colon cancer, and the following baseline and pathological characteristics of the two groups were compared: intraoperative condition, postoperative recovery, and postoperative complications. Our modified surgical method was to isolate the mesocolon using a cranial(the ligament of Treitz) -to- caudal(the pedicle of ileocolic) pathway and the orderly ligation of blood vessels in the SMA.

Results: There was no statistically significant difference in the baseline characteristics or pathological data between the two groups. Compared with the traditional SMA approach, the modified SMA approach had a shorter surgical time(P < 0.001) and vascular dissection time (P < 0.001) and less intraoperative blood loss (P = 0.000). There was no statistically significant difference in the number of total harvested lymph nodes or positive harvested lymph nodes between the two groups of patients (P > 0.05); There was no statistically significant difference in postoperative hospital stay, time to first flatus, time to pull out drainage tube and drainage between the two groups of patients (P > 0.05), and there was no statistically significant difference in the incidence of complications between the two groups of patients (P > 0.05).

Conclusion: The modified SMA approach in totally laparoscopic radical resection for right colon cancer can shorten the surgical and vascular dissection time, reduce intraoperative bleeding and reduce the surgical difficulty and intraoperative risk of the SMA approach for right colon cancer. In clinical practice, its safety and feasibility are relatively high, and it is worth promoting.

Trial registration: The study was approved by the Ethics Committee of The First Affiliated Hospital of Wannan Medical College and registered with the China Clinical Trials Registry (ChiCTR2300075919, Date of Registration:2023-09-19- retrospective registration) http://www.chictr.org.cn/index.aspx .