Background and Aims: Laparoscopic colectomy has been widely used in the radical operation for colon cancer, and selecting an appropriate surgical approach is essential for the surgical efficacy. Due to the complex of the vascular structures around the right colonic area, the degree of surgical difficulty of right hemicolectomy is relatively high, so the surgical approach should be selected cautiously. This study was conducted to compare the clinical efficacy of using caudal-to-cranial approach and medial approach the ideal surgical approach in laparoscopic colectomy, so as to determine an ideal surgical approach for this procedure.  
Methods: A total of 136 patients with right colon cancer admitted from May 2016 to May 2019 were enrolled. The patients were randomly assigned to two groups, with 68 cases in each group. Patients in one group underwent laparoscopic right hemicolectomy via caudal-to-cranial approach (caudal-to-cranial approach group), and those in the other group underwent laparoscopic right hemicolectomy via medial approach (medial approach group). The main clinical variables and postoperative survival rates between the two groups of patients were compared. 
Results: There were no differences in baseline data between the two groups of patients (all P>0.05). In caudal-to-cranial approach group, the average operative time (123.52 min vs. 168.64 min), average intraoperative blood loss (12.46 mL vs. 24.28 mL) and conversion rate (2.94% vs. 11.76%) were significantly superior to those in medial approach group (all P<0.05). There were no significant differences in time to gas passage, defecation and food intake as well as the drainage volume, drainage time, and length of hospital stay between the two groups (all P>0.05). The incidence rates of incision infection, pulmonary inflammation, anastomotic leakage and intestinal obstruction as well as the overall incidence of postoperative complications (23.53% vs.35.29%) in caudal-to-cranial approach group were significantly lower than those in medial approach group (all P<0.05). There was no significant difference in the number of lymph node dissection and postoperative TNM stage between the two groups (both P>0.05). The 2-year survival rate of caudal-to-cranial approach group was significantly higher than that of medial approach group (82.35% vs. 52.94%, P<0.05). 
Conclusion: Using caudal-to-cranial approach for laparoscopic right hemicolectomy has the advantages of being safe minimally invasive, simple and easily operable, which can ensure the adequate vision of the surgical field and the accurate anatomical positioning. Its short- and long-term efficacy are superior to those of using medial approach for laparoscopic right hemicolectomy.