Laparoscopic complete mesocolic excision right colectomy in obese patients

Background: Laparoscopic complete mesocolic excision (CME) right colectomy is a technically demanding procedure infrequently employed in Western centers. In addition, visceral obesity is associated to increased difficulties during laparoscopic procedures. This retrospective cohort study aims to analyze the safety of laparoscopic CME colectomy in viscerally obese patients compared to patients with normal values of visceral adipose tissue (VAT). Materials and Methods: Prospectively collected data from 73 patients who underwent laparoscopic CME right colectomy with D3 lymphadenectomy for right-sided colon cancer at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust between September 2014 and May 2021 were analyzed. All the procedures were carried out by a single surgeon (CP). Visceral adipose tissue (area was measured at pre-operative CT images and patients were divided in VO and Non-VO groups according to sex-specific cut-offs. Comparison of intra- and post-operative results were compared between groups. Results: No differences in clinical and pathological variables analyzed were found between groups except for a more advanced age at surgery (74.2 vs 68.9 years, p=0.003) and a higher Charlson's Comorbidiy Index (4 vs. 6, p <0.001) in the VO group. Visceral obesity was associated to a longer surgical time (240 vs. 187 min, p=0.03) and an increase in blood losses (50 vs. 30 ml, p=0.03). No difference in post-operative outcomes and length of stay were observed between the VO and Non-VO groups. Conclusions: In conclusion, laparoscopic CME right colectomy is feasible and safe even in VO patients which usually present unfavorable characteristics for laparoscopic approach. Nevertheless, the increase in surgical duration and blood losses, suggests a higher difficulty in VO patients even in experienced hands. Routine measurement of VAT should be consider to identify increased technical difficulty during the learning phase of laparoscopic CME right colectomy.