Laparoscopic Versus Open Complete Mesocolic Excision and Central Vascular Ligation in Right-Sided Colon Cancer: A Tertiary Center Experience

The prognosis of right colon cancer remains disappointing. Complete mesocolic excision with central vascular ligation, based on the same oncological principles of total mesorectal excision in rectal cancer, seems to be gaining popularity recently. All patients with right-sided colon cancer and matching eligibility criteria were enrolled in the study. A total of 114 patients were retrieved. They were categorized into two groups: open group (71 patients) and laparoscopic group (43 patients). In the laparoscopic group, surgery is performed from medial to lateral. After identifying the superior mesenteric vein (SMV) and ileocolic vessels, an incision is made in the ascending mesocolon alongside SMV, and then upward dividing the ileocolic vessels at their roots. In the open group, surgery is performed via a medial approach in a caudal-to-cranial direction. Mobilization of the right colon and its mesocolon is like laparoscopic CME technique. All surgeries were successful with significantly lower postoperative complications in the laparoscopy group (p value 0.034). No significant difference was found either in harvested lymph nodes or lymph node ratio (p value 0.72, 0.82). There was no significant difference in the cumulative 3-year overall survival (p value 0.17). Laparoscopy is technically safe and feasible with superior short-term clinical outcomes over open approach regarding less postoperative pain, blood loss, shorter hospital stay, and faster recovery. We found no significant difference between both groups in lymph node ratio, a finding that may indicate that the approach of complete mesocolic excision has no jeopardizing effect. Overall survival was not significantly different, but long-term outcomes require further study.