Surgical Treatment and Subsequent Outcome of Patients with Carcinoma of the Splenic Flexure

Nakagoe, Tohru; Sawai, Terumitsu; Tsuji, Takashi; Jibiki, Masaaki; Ohbatake, Masayuki; Nanashima, Atsushi; Yamaguchi, Hiroyuki; Yasutake, Toru; Kurosaki, Nobuko; Ayabe, Hiroyoshi; Ishikawa, Hiroshi

doi:10.1007/s005950170169

Cited by 81 publications

(47 citation statements)

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“…Some surgeons have argued that subtotal colectomy or extended right hemicolectomy improves oncological outcome (7,13). However, other studies have demonstrated that the prognosis for left hemi-colon cancer is no worse than for other colon cancers, and that left hemi-colectomy is sufficient for a satisfactory oncological outcome (8,9,14). A recent study showed that complete mesocolic excision in the mesocolic plane with central vascular ligation is associated with the removal of more mesocolon and a greater lymph node yield, and might improve 5-year survival (15).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted radical left hemicolectomy for colon cancer

Han¹,

Min²

2016

J. Vis. Surg.

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IntroductionLaparoscopic surgery has been enthusiastically applied to the resection of colorectal cancer for more than many years. Nowadays, more and more colorectal surgeons believe that laparoscopic approach gains quicker functional recovery, achieves comparable (1-3), and even better oncologic results (4,5) for the treatment of patients with colorectal cancer. However, the safety of laparoscopic left hemicolectomy for cancer remains to be established, owing to its exclusion from previous randomized controlled trials. Laparoscopic left hemi-colectomy, involving the takedown of splenic flexure, has been more challenging than the other laparoscopic colorectal procedures. Because there is the technical variability between colorectal surgeons, the clinical trial of laparoscopic left hemi-colectomy which required the takedown of splenic flexure for the curative resection of cancers and tension-free colonic anastomosis has been rare. This video article aims to describe safe and feasibility of laparoscopic left hemi-colectomy, authors would like to share the surgical techniques with you via a case of descending colonic neoplasm who underwent the laparoscopic left hemi-colectomy ( Figure 1) (6). DiscussionCancer of splenic flexure is rare, comprising only 2% to 5% of all colorectal cancers (7-10). Very few studies have specifically investigated the use of laparoscopic left hemicolectomy for cancer (11). However, surgical approaches for transverse or descending colon cancer vary considerably depending on the relative location of the tumor. Thus, the purpose of this video article is to show safe and efficiency for the tumor locates in the left hemi-colon.Laparoscopic left hemi-colectomy is suitable for the tumors locate in distal a third of the transverse colon, splenic flexure, descending colon and upper sigmoid colon. Left hemi-colectomy was defined as a procedure requiring division of the left colic and the left branch of the middle colic vessels at their origins. Generally, left hemi-colectomy was carried out for stage I/II/III tumors. Briefly, the surgeon and camera operator stood on the right side of the patient, with the first assistant positioned to the left or between the legs of the patient. Medial-to-lateral retroperitoneal dissection was performed to allow division of the left colic artery. The inferior mesenteric vein was divided near the inferior border of the pancreas. The omentum was then transected to allow entry into the omental bursa (lesser sac) and mobilization of the splenic flexure. The left branch of the middle colic vessels was identified at the inferior border of the pancreas and divided at its origin. The specimen was extracted through the camera port, which was extended to about 4-5 cm, and the anastomosis was formed extracorporeally by functional end-to-end anastomosis or intracorporeally by side-to-side anastomosis using linear staplers.The blood supply to distal a third of the transverse colon, splenic flexure, descending colon and upper sigmoid colon has been shown to vary between patient...

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Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted radical left hemicolectomy for colon cancer

Han¹,

Min²

2016

J. Vis. Surg.

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“…This concern has been varies among surgeons and institutes. Interestingly, Sadler et al [14], advocated extended right colectomy an option for SFC. He believed that lymph nodes metastasis could follow ileocolic artery in SFC but it had been rarely reported, hence then, left colectomy stated as the standard procedure of choice in SFC [2].…”

Section: Discussionmentioning

confidence: 99%

Optimum Level of Vessel Ligation in Splenic Flexure Cancer

Bandar¹,

Han²,

Sabilah³

et al. 2016

J Surg Surgical Res

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.17, respectively. Recurrence rate found relatively greater in LCA plus MMC group compared to of LCA plus LMA but haven't reached statistical significant, 16.6% vs. 10.52%, p=0.56, respectively. 5-year disease-free survival and overall survival rate were similar in both groups. Conclusion:Higher level of vessel ligation has not add significant different in overall outcome, however, has a potential role to lower the risk of recurrence rate in SFC patients.enhanced overall survival up to 15.6% when dissection take place in embryological planes. Moreover, central venous ligation and division of feeding vessel at the root have shown a successful concept to retrieved higher number of lymph node metastasis [8]. On top of that, higher number of lymph node harvested attributed in accurate staging [9]. CME principles for right-sided resection equivalent to the current TME principles for left sided resection. Therefore, optimal vessel ligation has been discussed and studied well in the right-sided colon cancer with anticipated success to achieve oncological benefits. However, guideline to determine the level of vessel ligation in SPC is still remained in debates. The concept of high vessel ligation is to include resection of the paracolic nodes, intermediate nodes and apical lymphnodes, which defined as D3 lymph-adenectomy. D3 lymph-adenectomy have been widely used and accepted in Japan, China and Korea [10][11][12]. In case of SFC, whether high level of vessel ligation is required to include LMC artery or not, yet has not been proposed. To our knowledge, this is the first study aiming to investigate the adequacy of vessel ligation in SFC in term of overall survival (OS) and local recurrence. Materials and Methods Patients

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“…In fact, both the SF and the transverse colon were never included in randomized controlled trials designed to assess the efficacy of laparoscopic surgery as a curative treatment for colon cancer [4,5]. The reasons for exclusion of SF cancer from the trials include technical difficulties with laparoscopic identification of the middle and left colic vessels and subsequent lymph node dissection.Other main controversies that contribute to the status of laparoscopic SF resection as a yet nonstandardized procedure involve the appropriate extent of surgery and the risk of inadvertent splenectomy [2,6]. Recommendations for SF cancer range from left partial resection to extended right hemicolectomy in association with splenectomy and distal pancreatectomy [2].…”

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confidence: 99%

“…Other main controversies that contribute to the status of laparoscopic SF resection as a yet nonstandardized procedure involve the appropriate extent of surgery and the risk of inadvertent splenectomy [2,6]. Recommendations for SF cancer range from left partial resection to extended right hemicolectomy in association with splenectomy and distal pancreatectomy [2].…”

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confidence: 99%