Surgical, Pathological and Exploratory Survival Outcomes Following a Superior Mesenteric Vein-First Approach to Right Colectomy and Extended Right Colectomy: A Retrospective Single-Center Series with Video Documentation from Azerbaijan.

Abstract

Background: Published regional data on right-sided colon cancer surgery from Azerbaijan are limited. This study reports perioperative, pathologic, and exploratory survival outcomes after standard and extended right colectomy in a consecutive institutional series.

Methods: A retrospective cohort study was performed using a prospectively maintained operative database of 89 patients who underwent superior mesenteric vein (SMV)-first right colectomy or extended right colectomy between August 2017 and April 2026. Both benign and malignant cases were included for perioperative safety analysis; oncological analyses were restricted to malignant disease.

Results: Median age was 66.0 (57.0-71.0) years, and 47 (52.8%) patients were male. Malignant disease was present in 83 (93.3%). Standard right colectomy was performed in 69 (77.5%) and extended right colectomy in 20 (22.5%). Median operative time was 260.0 (210.0-315.0) minutes. Any recorded Clavien-Dindo complication occurred in 8 (9.0%), major morbidity in 4 (4.5%), reoperation in 4 (4.5%), and anastomotic leak in 3 (3.4%). Median lymph-node harvest was 33.0 (28.0-39.8); 81 (98.8%) evaluable patients had at least 12 nodes examined. Among malignant cases, stages I, II, III, and IV were reconstructed in 5, 30, 35, and 13 patients, respectively. In 83 malignant cases with analyzable survival time, estimated overall survival at 1, 3, and 5 years was 88.4%, 80.5%, and 72.7%, respectively, while exploratory disease-free survival was 87.5%, 80.9%, and 65.6%.

Conclusions: In this institutional series, an SMV-first approach to right colectomy and extended right colectomy was associated with acceptable perioperative morbidity, a low anastomotic leak rate, and high lymph-node retrieval. The large proportion of stage III-IV disease underscores the need for earlier diagnosis and structured follow-up.