Abstract: 【Abstract】Objective:To investigate the feasibility of laparoscopic complete mesocolic excision (CME) with completely medial access by “pageturning” approach (CMAPA). 
Methods: The clinical data of 38 patients with rightsided colon cancer who were admitted to the Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine between September 2011 and December 2014 were analyzed retrospectively. All the patients underwent laparoscopic CME with CMAPA. The CMAPA was conducted in the “insidetooutside” and “bottomtotop” direction, which adopted the strategy of “pointtoline” and “linetoplane”. Observing indexes included the evaluation of surgical quality (according to the West grading system), intraoperative status (operation time, volume of intraoperative blood loss, extent and number of lymph node dissected and specimen length),postoperative recovery (time to anal exsufflation, time for fluid diet intake, duration of hospital stay and occurrence of complications) and postoperative pathological examination ［tumor staging according to the 7th edition staging system of Union for International Cancer Control (UICC)］. The followup was regularly performed by telephone interview up to March 2015, including abdominal symptoms, urination and defecation, body weight, routine blood test, tumor markers of digestive tract, abdominal computed tomography (CT) and recurrence and metastasis of tumor. Measurement data with normal distribution and count data were presented as  ±s and rate, respectively.
Results:The quality of rightsided colon cancer surgery in 38 patients showed 35 at the mesocolon with grade C and 3 inside the mesocolon with grade B. The operation time, volume of intraoperative blood loss, number of lymph node dissected and specimen length, time to anal exsufflation, time for fluid diet intake and duration of hospital stay were (128±36)minutes, (76±35)mL, 20±6, (22±6)cm, (2.5±1.8)days, (3.6±2.1)days and (12±5)days, respectively. Of 16 patients with tumors of hepatic flexure of colon, 2 had No 6 lymph node metastases and 1 had lymph node metastasis at the side of greater curvature of stomach and greater omentum. Of 3 patients with postoperative complications, 1 with anastomotic leakage was cured by lavage and drainage, 1 with hemorrhage at the side of greater curvature of stomach had a good recovery after reoperation and 1 with chyle leakage had improvement after symptomatic treatment. Of 38 patients with rightsided colon cancer, cecum cancer was detected in 8 patients, ascending colon cancer in 14 patients and  cancer of hepatic flexure of colon in 16 patients. There were 10 lowdifferentiated adenocarcinomas, 18 moderatedifferentiated adenocarcinomas, 6 highdifferentiated adenocarcinomas and 4 mucinous adenocarcinomas. The postoperative pathological examination showed that stage I was detected in 2 patients, stage II in 20 patients and stage III in 16 patients. Thirtyeight patients were followed up for a median time of 18 months (range, 3-36 months), with normal abdominal symptoms, urination and defecation, body weight, routine blood test, tumor markers of digestive tract and abdominal CT and without complications. Two patients had tumor metastases, including 1 of liver metastasis and 1 of pulmonary metastasis. No death occurred during the followup.
Conclusion:Laparoscopic CME with CMAPA is technically feasible and complies more with the principle of tumor radical surgery, giving satifactory shortterm effect in patients.