대한대장항문학회

The aim of this study was to find out an effective method of laparoscopic oncologic<br>right hemicolectomy based on vascular anatomy of the right colon and patterns of<br>lymph node metastasis.<br>From September 1994 to November 1997,20 hemodynamically stable patients received<br>curative laparoscopic-assisted right hemicolectomy for adenocarcinoma by one surgeon.<br>Simultaneously anatomic variations of right colonic vessels and patterns of lymph node<br>metastasis were analyzed. All operations were performed by laparoscopic-assisted<br>method that consisted of intracorporeal mobilization of the right colon followed by<br>extracorporeal resection and anastomosis and lymph node dissection up to superior<br>mesenteric vessels under direct vision through mini-incision just above the root of<br>superior mesenteric vessels.<br>Ileocolic (ICA) and mid colic artery (MCA) existed constantly (100%), right colic<br>artery (RCA) existed only in 12 cases (60%). Mean distance from origin of MCA to<br>ICA was 3.2cm. Mean number of lymph nodes harvested from SMA area was 2.9 per<br>case. In 2 cases, they showed metastasis. Astler-Coilers stage Bl, B2, Cl, C2 were<br>distributed in 6, 8, 1, 5 cases respectively. Mean number of lymph node dissected and<br>length of resection margin was 29.3 and 8.7 cm. Operative time, time to oral intake,<br>hospital stay was 187 minutes,2.6 days,7.2 days, respectively. Open conversion was<br>needed in 1 case due to duodenal invasion. Mean 14 months follow-up showed 2<br>recurrences. One who have had duodenal wedge resection due to cancer invasion<br>underwent reresection of duodenum because of duodenal recurrence 12 months after the<br>first operation. The other suddenly died of myocardial infarction after operation for<br>ovarian recurrence 8 months later to her right hemicolectomy.<br>Right colonic vascular anatomy was so various but the area from MCA to ICA was<br>constantly within 4 cm and, lymph nodes in that area must be cleared. Therefore,<br>laparoscopic intracorporeal mobilization and extracorporeal resection of the right colon<br>and lymph node dissection through small incision was effective, safe and one of the best<br>method to get advantages of laparoscopic and open surgery simultaneously.<br>