An elderly patient presented with abdominal pain and anemia, prompting further evaluation. Colonoscopy with biopsy revealed a diagnosis of carcinoma of the ascending colon, and staging workup suggested a locally advanced disease (cT3N1M0) without distant metastasis.

The patient underwent a laparoscopic right radical hemicolectomy with D3 lymphadenectomy, including central vascular ligation (CVL). This approach ensures en bloc resection of the tumor along with complete mesocolic excision and high ligation of feeding vessels, facilitating optimal lymph node clearance.

 

🔬 Oncological Principles

Adequate oncological surgery in colon cancer is defined not only by removal of the primary tumor, but also by:

• Complete mesocolic excision (CME)
• D3 lymph node dissection with central vascular ligation
• Clear proximal and distal margins

These principles are critical in achieving better long-term oncologic outcomes, including reduced recurrence and improved survival.

 

⚙️ Advantages of the Laparoscopic Approach

In appropriately selected patients, laparoscopic surgery offers:

✔ Enhanced magnified visualization for precise dissection
✔ Reduced intraoperative blood loss
✔ Lower postoperative pain
✔ Faster recovery and early mobilisation
✔ Shorter hospital stay
✔ Comparable oncological outcomes to open surgery

 

This case highlights how minimally invasive surgery can be safely applied even in elderly patients with locally advanced disease, without compromising oncological clearance.