Abstract: Objective:To investigate the clinical efficacy of unidirectionalloop caudalmedial approach for laparoscopicassisted radical resection of right colon cancer.
Methods:The retrospective and descriptive study was performed. The clinical data of 37 patients who underwent laparoscopicassisted radical resection of right colon cancer through unidirectionalloop caudalmedial approach at the Sixth Affiliated Hospital of Sun Yatsen University from January 2015 to March 2016 were collected. Tumorfree principle was followed and unidirectionalloop caudalmedial 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) followup. 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, highdifferentiated adenocarcinoma, moderatedifferentiated adenocarcinoma and lowdifferentiated adenocarcinoma. (4) Followup: 37 patients were followed up for 3-17 months with a median time of 11 months. During the followup, 1 patient was complicated with anastomotic recurrence and 4 with distant metastases, the other 32 patients had tumorfree survival. Conclusion:Unidirectionalloop caudalmedial approach for laparoscopicassisted radical resection of right colon cancer is safe and feasible, with a good shortterm outcome, and it should be widely spread.