Right Colic Lymphadenopathy Clinical Trial
Official title:
A Randomized Controlled Clinical Trial to Investigate the Effect of SMA- or SMV- Orientated Laparoscopic Right Hemicoloectomy for Right Colon Cancer With a Medial-to-lateral Approach
A randomized controlled clinical trial to compare the outcomes of SMA- and SMV- orientated laparoscopic right hemicoloectomy for right colon cancer with a medial-to-lateral approach
In 2008, Germany scholar W. Hohenberger proposed the idea of complete mesocolic excision
(CME) and central vascular ligation (CVL) for the standardization of colonic cancer surgery.
This concept has been widely recognized and accepted. This radical operation attempts to
remove the mesocolon intactly by careful dissection along the embryologic tissue planes and
transection of the supplying vessels at their origin. For right-sided colon cancer, this
approach involves division of the vessels at their origin from the superior mesenteric artery
(SMA) and superior mesenteric vein (SMV). In our opinion, full exposure of the SMA and SMV is
necessary to make sure that the origin of the colonic arteries being truly exposed and tied
centrally at their origin and a maximal harvest of the regional lymphnodes. For locally
advanced colon cancer, SMA- orientated surgery may be more meaningful to recerve a radical
lymphadenectomy and bring benefit for their survival. However, in the traditional practise,
the lymph node dissection is orientated by SMV and SMA is not exposed, tissue around SMA is
left behind.
In this study, eligible patients with right colon cancer will be randomly allocated to
receive either SMA- or SMV- orientated laparoscopic right hemicoloectomy. 100 patients will
be enrolled in each group. In SMV- orientated surgery group, SMA is not exposed and the left
boundary of resection is the left side of SMV. In SMA- orientated surgery group, the left
boundary of resection is the left side of SMA and SMA is exposed.Artery sheath is not
necessarily to be opened. Postoperative pathology will be analyzed with the number of lymph
nodes retrieved. Postoperative recovery process and long term survival will be followed.
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