Clinical application of the caudal-to-dorsal priority combined with cephalic approach in laparoscopic radical resection of right colon cancer

Abstract Objective The objective of this study is to examine the safety and feasibility of laparoscopic total colonic mesenteric resection for radical right hemicolectomy, utilizing a caudal-to-dorsal priority access approach in combination with a cephalic approach.Methods This study aims to conduct a retrospective analysis of the clinical data of 56 patients diagnosed with right hemi-colon cancer, who underwent radical right hemi-colon resection through laparoscopic total colonic mesenteric resection with caudal-to-dorsal priority, combined with cephalic approach, between January 2021 and June 2022.Results All 56 cases were completed without any instances of open surgery. The average operative time was (153.8 ± 42.5) minutes, with an average intraoperative bleeding of (53.3 ± 21.3) mL. The average time to first gas after surgery was (58.3 ± 13.6) hours, while the average time to return to a liquid diet was (68.5 ± 19.6) hours. The average postoperative hospital stay was (6.1 ± 3.0) days. Following surgery, two cases of lymphatic fistula and one case of anastomotic bleeding were reported. Following conservative treatment, all cases were cured, and no perioperative deaths were reported. Post-operative pathological results indicated that all cases were diagnosed with adenocarcinoma, with an average of 20.1 ± 5.9 lymph nodes cleared. Tumor staging revealed 8 cases in stage I, 19 cases in stage IIA, 11 cases in stage IIB, 12 cases in stage IIIA, and 6 cases in stage IIIB. During the 12-month postoperative follow-up, no instances of recurrence, metastasis, or death were observed.Conclusions The utilization of a caudal-to-dorsal priority in conjunction with a cephalic approach during laparoscopic radical resection of right hemicolectomy is a secure and viable method that aligns with the fundamental principles of radical oncology. This technique can aid in reducing the learning curve for surgeons performing laparoscopic right hemicolectomy and in guaranteeing surgical safety.