# Laparoscopic Right Hemicolectomy With Gastrocolic Trunk Resection for Advanced Transverse Colon Cancer

## TL;DR

This paper describes a laparoscopic surgical technique for treating advanced transverse colon cancer by resecting the gastrocolic trunk.

## Contribution

The paper introduces a novel laparoscopic approach combining cranial and caudal techniques for gastrocolic trunk resection.

## Key findings

- The procedure was successfully performed in a patient with advanced transverse colon cancer and lymph node metastasis.
- A combined cranial and caudal approach allows safe resection while preserving critical vascular structures.
- The technique emphasizes careful management of the anterior superior pancreaticoduodenal veins to avoid complications.

## Abstract

Locally advanced right-sided colon cancer sometimes requires advanced procedures in addition to normal complete mesocolic excision. We describe laparoscopic right hemicolectomy with gastrocolic trunk (GCT) resection. A 48-year-old woman was diagnosed with right transverse colon cancer and severe lymph node metastasis. Bulky lymph nodes were in contact with the superior mesenteric vein (SMV) that invaded the root of the GCT. Curative laparoscopic right hemicolectomy with GCT resection was performed. GCT resection was performed using both cranial and caudal approaches. First, we ligated the distal side of the GCT from the cranial side and dissected the mesocolonic root from the pancreas. Then, we moved to the caudal view. The root of the GCT was ligated, and the resected GCT was mobilized from the pancreatic head while carefully coagulating the anterior superior pancreaticoduodenal veins (ASPDVs) using an ultrasonically activated device (USAD). The patient’s postoperative course was favorable. Approaching the GCT from both the cranial and caudal sides, considering the limited handling axis of laparoscopy, is useful for performing this procedure safely. The cranial approach is important for creating a cranial safety zone before transitioning to the caudal approach. The pitfall is that the ASPDVs should not be managed in this step because the head of the USAD will contact the pancreatic head owing to the handling axis. ASPDVs should be managed using the caudal approach with a cranial safety zone. Although rarely performed, this procedure is sometimes essential for the treatment of advanced right-sided colon cancer.