LAPAROSCOPIC RIGHT HEMICOLECTOMY WITH COMPLETE EXCISION OF THE MESOCOLON

Case Presentation Patient: O.M.L, 69 years old, presented with melena, weakness for about a year, and a 10 kg weight loss over the past month. Colonoscopy revealed an extensive vegetating lesion in the cecum, 8 cm in size, with histopathology compatible with adenocarcinoma. Initial exams showed a CEA of 2.2, no distant metastases, and a CT scan of the abdomen revealed suspected lymphadenopathy at the root of the superior mesenteric vessels. The patient underwent right hemicolectomy with complete mesocolon excision (CME) and creation of an isoperistaltic side-to-side ileotransversoanastomosis intracorporeally via laparoscopy. The specimen was removed through a transverse suprapubic incision. The histopathological examination of the surgical specimen revealed medullary carcinoma of the right colon – pT3pN0 (00/61). The patient was discharged on the third postoperative day and is under oncological follow-up.

Discussion Complete mesocolon excision in the treatment of colon cancer was introduced to ensure inclusion of the central lymph nodes during lymphadenectomy at the vascular root. The procedure involves separating the mesocolic and parietal planes, exposing the superior mesenteric vein to dissect all lymphatic tissue and performing central ligation of the colic vessels and Henle’s trunk vessels, including potentially involved lymph nodes. Special attention must be given during lymphadenectomy, which should only involve the lateral side of the superior mesenteric vein while preserving the gastric colic trunk vessels.

Conclusion In the management of advanced right colon cancer, complete mesocolon excision with central ligation of the vessels plays a key role in ensuring proper oncological surgery for large tumors with suspected lymph nodes at the root of the mesentery. In our practice, this technique is performed selectively, not routinely. This video demonstrates that the laparoscopic approach is feasible and safe; however, due to the higher technical difficulty and potential bleeding, the surgeon's skill and knowledge of the anatomical structures are crucial for the quality and safety of the procedure.

Publication History

Article published online:
25 April 2025