Comparative Analysis of the Superior Mesenteric Artery and Modified SMA Approaches in Totally Laparoscopic Radical Resection for Right Colon Cancer: Impact on Operative Outcomes and Complications.

[BACKGROUND] The superior mesenteric artery (SMA) approach aids laparoscopic right colectomy but relies on one landmark. The modified SMA (M-SMA) adds the ligament of Treitz as a second reference to improve safety and efficiency in complex anatomy.

[METHODS] This retrospective analysis included 306 patients who underwent totally laparoscopic radical resection for right-sided colon cancer, divided into the SMA group ( = 147) and the M-SMA group ( = 159). Propensity score matching was applied to balance baseline characteristics. Intraoperative outcomes-including operative time, blood loss, and postoperative complications-were compared between groups.

[RESULTS] The M-SMA group demonstrated significantly shorter operative times and reduced intraoperative blood loss ( < .05). The overall postoperative complication rate was also significantly lower in the M-SMA group (11.3% vs. 23.8%,  = .004), with the most notable reduction observed in the incidence of chylous fistula. No significant differences were found in lymph node yield, length of hospital stay, or overall recovery.

[CONCLUSIONS] The M-SMA approach demonstrates clear perioperative advantages over the traditional SMA technique, including reduced blood loss and a lower complication rate. It may represent a safer and more effective option for patients with complex vascular anatomy undergoing laparoscopic right hemicolectomy.