A commentary on "Anatomic patterns and clinical significance of gastrocolic trunk of Henle in laparoscopic right colectomy for colon cancer: Results of the HeLaRC trial" (Int J Surg. 2022;104:106718)

Dear Editor, We took great interest to read the article by He et al. [1] entitled “Anatomic patterns and clinical significance of gastrocolic trunk of Henlé in laparoscopic right colectomy for colon cancer: Results of the HeLaRC trial” published online in August 2022 in International Journal of Surgery. In this study, the authors investigated the anatomic patterns of the gastrocolic trunk of Henlé (GTH) region in laparoscopic right colectomy with D3 lymphadenectomy (D3-RC), and analyzed the clinical significance based on a recent nationwide multicenter study. They found that type I GTH, T1 stage and tumor location at ileocecal or ascending colon correlated with shorter exposure time of the GTH region, short length of GTH and tumor location (transverse colon vs. non transverse colon) correlated with the amount of GTH bleeding during surgery. As a result, these findings can lead to a safer operation with better oncologic quality. D3-RC is still a demanding procedure because of vascular variations especially in the GTH region [2]. To reduce the difficulty of surgical dissection, several different approaches have been developed and have shown their feasibility in D3-RC [3–17]. However, reports focusing on the exposure time of the GTH region and the amount of GTH bleeding among these studies are rare (Table 1). Meanwhile, the study by He et al. did not analyze whether the surgical approach was related to the difficulty of GTH dissection. If their study revealed a certain approach to be associated with reduced GTH exposure time or decreased amount of GTH bleeding based on the type of GTH and the tumor location, then this approach should be recommended as the preferred procedure. Although the optimal approach of D3-RC has not been standardized, standardization of operative approach can help to increase the safety of this oncological surgery for individual patients and shorten the learning curve for less-experienced surgeons [18].Table 1: Approaches in laparoscopic right colectomy with D3 lymphadenectomy.The Discussion in this article stated that besides the anatomic variations of GTH, some other factors can cause an increase chance of avulsion of the GTH with life-threatening bleeding, meaning that hemorrhage is inevitable in some cases [19]. Once bleeding occurs, it may make the operative field less visible and further increases the difficulty of surgery. In dissecting the GTH region, it is equally important to find out whether bleeding is likely to occur somewhere around the GTH region (such as the trunk or a certain branch), and find out the effective method to stop the bleeding (such as compression, bipolar coagulation, titanium clips or tissue clips). We suggest the authors to compare the different bleeding sites and the useful hemostatic techniques, thus helping the surgeon to be more cautious in some areas when dissecting and to better prepare him/her to control the bleeding. We respectfully appreciate that He et al. have provided us with a very important study which brings us better understanding of the GTH region and the spatial orientation relevant to surgical outcomes in laparoscopic right colectomy with D3 lymphadenectomy. It may be helpful to recommend the appropriate surgical approach and reasonable hemostatic technique to increase the safety of this challenging operation based on tumor location and the typo of GTH. Ethical approval None. Sources of funding None. Author contribution The original idea of this research was conceived by Wenjun Luo, Wenjun Luo and Tingting Lu participated in writing the first draft.Wenjun Luo reviewed the manuscript. All authors approved the last version of this manuscript. Research registration Unique Identifying number (UIN) 1 Name of the registry: NA. 2 Unique Identifying number or registration ID: NA. 3 Hyperlink to your specific registration (must be publicly accessible and will be checked): NA. Guarantor Wenjun Luo. Provenance and peer review Commentary, internally reviewed. Declaration of competing interest None. Wenjun Luo Tingting Lu Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, 629000, Sichuan, China E-mail addresses:[email protected]