Clinical Application of Modified Posterior Approach for Laparoscopic Radical Resection of Right-Sided Colon Cancer
Objective To explore and analyze the key points and difficulties of the modified posterior approach for laparo-scopic radical resection of right-sided colon cancer,as well as the scope of lymphatic clearance during the procedure.Meth-ods A retrospective analysis was conducted on the perioperative clinical data of 124 patients who underwent laparoscopic radical resection of right-sided colon cancer at the Second People's Hospital of Yinan County from April 1,2015,to April 1,2022.Among them,46 cases underwent the modified posterior approach(modified posterior approach group),and 78 ca-ses underwent the traditional median approach(traditional approach group).By comparing the general information,intrao-perative and postoperative data,and postoperative pathological data of the two groups,this study analyzed the surgical safety,postoperative recovery,and tumor radicality of the modified caudal approach for right hemicolectomy with complete mesocolic excision(CME)combined with D3 lymphadenectomy.Results No severe complications or deaths occurred in ei-ther group.The operation time of the modified posterior approach group[140(135.0,140.0)min]was shorter than that of the traditional approach group[195.0(185.0,205.0)min],with a statistically significant difference(P＜0.01).The intraoperative blood loss in the modified posterior approach group[35.0(35.0,40.0)mL]was less than that in the tradi-tional approach group[85.0(80.0,90.0)mL],with a statistically significant difference(P＜0.01).The total number of lymph nodes retrieved in the modified posterior approach group(18.41±1.25)was higher than that in the traditional approach group(17.31±1.49),with a statistically significant difference(P＜0.01).The number of positive lymph nodes obtained in the modified posterior approach group[0.50(0,3.60)]was higher than that in the traditional approach group[0(0,1.00)],but the difference was not statistically significant(P＞0.05).Intraoperative and postoperative pathological and prognostic indicators showed that there was no statistically significant difference in the rate of conversion to open sur-gery between the modified posterior approach group(2.21％)and the traditional approach group(7.60％)(P＞0.05).There were no statistically significant differences between the two groups in terms of first exhaust time,time to resume liquid diet,total hospital stay,postoperative hospital stay,and postoperative complication rate(all P＞0.05).Conclusion The laparoscopic modified posterior approach for right hemicolectomy with complete mesocolic excision(CME)combined with D3 lymph node dissection has a shorter operation time,less intraoperative bleeding,and can obtain a larger number of total lymph nodes,which is in line with the principles of tumor radical resection.
modified posterior approach combined with median approachradical resection of right-sided colon cancerprimi-tive retroperitoneal spacegastrocolic trunkinfrapyloric lymph nodesgreater omentum
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