[Focused issues and prospects of laparoscopic right hemicolectomy].
摘要
The standardization of laparoscopic right hemicolectomy for colon cancer has been driven by advancements in anatomy and surgical technology, but controversies persist regarding lymph node dissection (LND) extent and surgical plane selection. In the concept of LND, both D3 radical resection and complete mesocolic excision (CME) theoretically define the left side of the superior mesenteric artery (SMA) as the boundary for lymphadenectomy, though their clinical values remain to be validated. China's RELARC study shows higher vascular injury rates,but it offers survival benefits in stage III patients. Regarding intestinal resection length, Japanese research confirms that most lymph node metastases are confined within 10 cm of the tumor, indicating that excessive resection may be unnecessary. Exploration of ileocecal-preserving techniques provides new directions for functional preservation. Controversies over LND boundaries focus on the left side of the superior mesenteric vein (SMV) versus the left side of the SMA. Although SMA-left dissection aligns better with lymphatic drainage anatomy, high-quality evidence is lacking. The multi-center RCT (MARCH study) conducted by our team is currently investigating its value for stage III patients. In precision diagnosis and treatment, preoperative imaging features, intraoperative lymphatic tracing, and radiomics models assist in lymph node assessment, but specificity remains insufficient. The application of membrane anatomy concepts in surgical plane selection still requires embryological research to clarify the structure of fused fascia. Future research should focus on standardizing dissection ranges, improving precision in metastasis prediction, and clarifying anatomical planes to promote more precise and personalized surgical approaches.