Laparoscopic Right Hemicolectomy for Cecal Cancer

A right hemicolectomy (right colectomy) for malignant disease involves the resection of the terminal ileum, right colon, and proximal transverse colon followed by ileocolic anastomosis. The extent of resection required depends on the tumor margin and the need for adequate oncologic lymphadenectomy as defined by the blood supply. Guidelines for colorectal cancer recommend a 5-cm margin, both proximally and distally, for adequate tumor resection and a minimum of 12 lymph nodes for complete lymphadenectomy. For tumors in the cecum and proximal right colon, a standard right hemicolectomy is performed, with the line of resection extending to the proximal transverse colon and the level of the right branch of the middle colic artery. However, an extended right hemicolectomy may be required for lesions closer to the hepatic flexure, in which case the resection must extend to include the entire middle colic artery territory. In general, an ileocolic anastomosis is preferred to a colocolic anastomosis, owing to the superior blood supply of the former. The right colon lies in very close proximity to the duodenum, necessitating careful dissection to achieve full colonic mobility.