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Introduction Persistent descending mesocolon (PDM) represents a failure of fusion of the descending mesentery, leading to anatomical abnormalities. This study aimed to examine the effects of anatomical features of PDM on laparoscopic surgical outcomes. Methods Patient backgrounds, surgical outcomes, anatomical characteristics, and operative findings were retrospectively compared between 186 patients classified into PDM and non‐PDM groups who underwent primary resection for left‐sided colon and rectal cancer at our hospital from January 2019 to December 2020. Results PDM was diagnosed in nine patients (4.8%). The operative time (337 ± 165 vs 239 ± 107 min, p = 0.010) was significantly different between PDM and non‐PDM groups, but bleeding loss was not different (108 ± 97 ml vs 53 ± 142 ml, p = 0.259). In PDM patients, in addition to abnormal fixation of the sigmoid‐descending colon junction, adhesion of the mesentery of the colon and small intestine in 100%, and adhesion between the mesocolon in 33% patients was confirmed intraoperatively. Ileus was more common in the PDM group (two cases, 22%) and in the non‐PDM group (10 cases, 5.6%), but there was no significant difference in overall postoperative complications between the two groups (p = 0.215). The duration of postoperative hospital stay (28 ± 20 vs 16 ± 11 days, p = 0.002) was significant between the two groups. The left colonic artery (LCA) could not be preserved in six patients in the PDM group, one of whom had anastomotic leakage and two of whom required additional resections due to intraoperative intestinal blood flow failure. Conclusion PDM prolonged operative times and duration of postoperative stay in laparoscopic surgery for left‐sided colon and rectal cancer. Division of the LCA in PDM patients should be considered an intraoperative risk factor for injury to the marginal artery.

Introduction The impact of obesity on short‐term outcomes after laparoscopic colorectal surgery (LAC) in Asian patients is unclear. The purpose of the present multicenter study was to evaluate the safety and feasibility of LAC in obese Japanese patients. Methods We retrospectively reviewed 1705 patients who underwent LAC between April 2016 and February 2019. Patients were classified according to body mass index (BMI): non‐obese (BMI < 25 kg/m2, n = 1335), obese I (BMI 25‐29.9 kg/m2, n = 313), and obese II (BMI ≥30 kg/m2, n = 57). Clinical characteristics and surgical outcomes were compared among the three groups. Results The proportion of patients with comorbidities (non‐obese, 58.1%; obese I, 69.6%; obese II, 75.4%; P < .001) and median operation time (non‐obese, 224 minutes; obese I, 235 minutes; obese II, 258 minutes; P = .004) increased significantly as BMI increased. The conversion rate was similar among the groups (P = .715). Infectious complications were significantly high in obese II patients (non‐obese, 10.4%; obese I, 8.3%; obese II, 28.1%; P < .001). Multivariate analysis revealed that in obese II patients, BMI was an independent predictive factor of infectious postoperative complications (odds ratio 2.648; 95% confidence interval, 1.421‐4.934; P = .002). Conclusion: LAC has an increased risk of postoperative infectious complications in obese II patients, despite improvements in surgical technique. Management of obese II colorectal cancer patients requires meticulous perioperative management.

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Single-incision laparoscopic surgery (SILS) has the potential to improve perioperative outcomes, including less postoperative pain, shorter operation time, less blood loss, and shorter hospital stay. However, SILS is technically difficult and needs a longer learning curve. Between April 2016 and September 2019, a total of 198 patients with clinical stage I/II right colon cancer underwent curative resection. In the case of the SILS approach, an organ retractor was usually used to overcome SILS-specific restrictions. The patients were divided into two groups by surgical approach: the SILS with organ retractor group (SILS-O, n = 33) and the conventional laparoscopic surgery group (LAC, n = 165). Clinical T status was significantly higher in the LAC group (p = 0.016). Operation time was shorter and blood loss was lower in the SILS-O group compared to the LAC group (117 vs. 197 min, p = 0.027; 10 vs. 25 mL, p = 0.024, respectively). In the SILS-O group, surgical outcomes including operation time, blood loss, number of retrieved lymph nodes, and postoperative complications were not significantly different between those performed by experts and by non-experts. Longer operation time (p = 0.041) was significantly associated with complications on univariate and multivariate analyses (odds ratio 2.514, 95%CI 1.047–6.035, p = 0.039). SILS-O was safe and feasible for right colon cancer. There is a potential to shorten the learning curve of SILS using an organ retractor.