A novel and safe approach: middle cranial approach for laparoscopic right hemicolon cancer surgery with complete mesocolic excision

Songtao Du, Bomiao Zhang, Yanlong Liu, Peng Han, Chengxin Song, Fangjie Hu, Tianyi Xia, Xiangxin Wu, Binbin Cui

Mastering right hemicolectomy techniques using laparoscopy in colorectal cancer surgery is very difficult. Although the long-term prognosis of laparoscopic right hemicolectomy (LRH) and complete mesocolic excision is unquestionable, different surgeons have their own opinions on routes of conducting LRH. LRH surgery is very complex due to the upper abdominal anatomical structure and vascular variation. Therefore, it has been considered the most difficult of all colorectal cancer surgeries. Our innovative middle cranial approach (MCA) was developed to avoid unnecessary injuries and minimize the operative time, thereby reducing the patient's hospital stay and improving their short-term prognosis. We compared 90 colon cancer patients who underwent the MCA between January 2016 and January 2017 with 82 patients who underwent the conventional central approach conducted by the same group of physicians (with Dr Cui as the surgeon) from 2011 to 2015. A short-term statistical analysis was performed. A total of 90 patients were included: 43 men and 47 women. Twenty-three patients underwent abdominal surgery (including stomach, rectum, and sigmoid colon surgery; appendectomy; and uterine attachment surgery). The median age of these patients was 62.6 (28-85) years; the median BMI was 22.9 (14.7-33.3) kg/m2; the mean bleeding volume was 53.9 (10-100) ml; the mean tumour diameter was 5.7 (0.8-9) cm, and the average number of lymph nodes detected was 19.2 (7-49). Our study showed that radical resection of right-sided colon cancer using the MCA was safe and feasible for the treatment of colorectal cancer patients.