A Clinical Study on Different Surgical Approaches for Laparoscopic Right Hemicolectomy

Objective To evaluate and compare the surgical outcomes of different approaches used in laparoscopic right hemicolectomy. Methods A retrospective analysis was conducted on 118 patients with right-sided colon cancer treated from January 2019 to August 2025.Among them,59 underwent the caudal-to-cranial approach(CA) and 59 underwent the medial-to-lateral approach(MA). Operative time, intraoperative vascular injury, blood loss, and lymph node yield were compared between groups. Postoperative recovery indicators (such as postoperative time to first flatus) and complications (including wound infection, anastomotic leakage, pulmonary infection, early intestinal obstruction, and urinary tract infection) were also assessed. Statistical analyses were performed using SPSS version 26.0. Results There were no significant differences in sex or age between the two groups (P > 0.05). Intraoperatively, one patient in the caudal group developed rupture of the henle’s trunk, and one patient in the medial group experienced bleeding due to superior mesenteric vein (SMV) rupture; both required conversion to open surgery. All other procedures were completed successfully, with no injuries to the gonadal vessels or duodenum observed. The operative time was significantly shorter in the CA group compared with the MA group [155.00 (133.00,180.00) min vs. 173.00 (160.00,180.00) min; P < 0.05].Blood loss was significantly lower in the CA group compared with the MA group [100.00 (50.00–225.00) mL vs. 120.00 (60.00–200.00) mL],P < 0.05.No significant differences were found between the two groups in lymph node harvest, time to first flatus, or postoperative complication rates. Conclusion The caudal-to-cranial approach demonstrates advantages in reducing operative time and intraoperative blood loss, while there were no significant differences in lymph node dissection, postoperative recovery, or complication rates; however, this study suggests that the procedure is a safe and feasible option for laparoscopic right hemicolectomy.Both approaches were safe and feasible and the caudal-to-cranial approach was beneficial in terms of the operative time and blood loss.