Colonic splenic flexure carcinoma: is laparoscopic segmental resection a safe enough oncological approach?

Ardu, Massimiliano; Bergamini, Carlo; Martellucci, Jacopo; Prosperi, Paolo; Valeri, Andrea

doi:10.1007/s00464-019-07221-y

Cited by 10 publications

(9 citation statements)

References 20 publications

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“… 11 , 12 , 21 , 22 The conversion rate was only 0.48% after surgery with our standardized technique, whereas those in other series have ranged from 3.0 to 7.3%. 11 , 12 , 23 – 25 Moreover, the rate of postoperative surgical complications using our procedure was only 6.28%, which is comparable with those in other studies, ranging from 6% to 33.6%. 23 – 27 We did not observe any cases of splenectomy associated with iatrogenic splenic injury after using the FACT method for splenic flexure mobilization.…”

Section: Discussionsupporting

confidence: 89%

Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score–weighted Cohort Study

Hsu

Chern

Jhuang

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Section: Discussionsupporting

confidence: 89%

Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score–weighted Cohort Study

Hsu

Chern

Jhuang

et al. 2020

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Today, when there is little doubt that more extensive lymphadenectomy leads to improved oncological outcomes [18][19][20][21][22], it seems natural to consider the position of the MCA bifurcation as the key element not only while performing right colectomy, but even more so for a left-sided colonic resection [23][24][25]. After developing Toldt I and III plane [9,26] underneath IMV, the crucial step in mobilizing the splenic flexure is to enter the lesser sac through the transverse mesocolon usually above the ligament of Treitz or the terminal arch of IMV [27].…”

Section: Discussionmentioning

confidence: 99%

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

et al. 2021

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Background The impact of the position of the middle colic artery (MCA) bifurcation and the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy when operating colon cancer have as of yet not been described and/or analysed in the literature. The aim of this study was to determine the MCA bifurcation position to anatomical landmarks and to assess the trajectory of aMCA. Methods The colonic vascular anatomy was manually reconstructed in 3D from high-resolution CT datasets using Osirix MD and 3-matic Medical and analysed. CT datasets were exported as STL files and supplemented with 3D printed models when required. Results Thirty-two datasets were analysed. The MCA bifurcation was left to the superior mesenteric vein (SMV) in 4 (12.1%), in front of SMV in 17 (53.1%) and right to SMV in 11 (34.4%) models. Median distances from the MCA origin to bifurcation were 3.21 (1.18–15.60) cm. A longer MCA bifurcated over or right to SMV, while a shorter bifurcated left to SMV (r = 0.457, p = 0.009). The main MCA direction was towards right in 19 (59.4%) models. When initial directions included left, the bifurcation occurred left to or anterior to SMV in all models. When the initial directions included right, the bifurcation occurred anterior or right to SMV in all models. The aMCA was found in 10 (31.3%) models, following the inferior mesenteric vein (IMV) in 5 near the lower pancreatic border. The IMV confluence was into SMV in 18 (56.3%), splenic vein in 11 (34.4%) and jejunal vein in 3 (9.4%) models. Conclusion Awareness of the wide range of MCA bifurcation positions reported is crucial for the quality of lymphadenectomy performed. The aMCA occurs in 31.3% models and its trajectory is in proximity to the lower pancreatic border in one half of models, indicating that it needs to be considered when operating splenic flexure cancer.

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“…Some retrospective research has been conducted to compare the segmental splenic flexure resection, the LHC, and the ERC to the lymphadenectomy. Ardu (10) reported that the segmental colectomy may not fulfill the recommended criteria that at least 12 lymph nodes be harvested, but found that the segmental colectomy was not more inferior in terms of OS and DFS than the ERC or LHC. Additionally, Faucheron et al (11) reported that the segmental left colectomy had a relatively low morbidity and good function in SFC.…”

Section: Discussionmentioning

confidence: 99%

Single-docking robotic-assisted artery-guided segmental splenic flexure colectomy for splenic flexure cancer—a propensity score-matching analysis

Zhang¹,

Song²,

Zhang³

et al. 2021

J Gastrointest Oncol

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Background: Splenic flexure cancer (SFC) is a rare condition in colorectal cancer (CRC). The appropriate surgical treatment for SFC remains controversial. In recent years, we have used artery-guided segmental splenic flexure colectomy (ASFC) to treat SFC in which robotic access is gradually applied. The study sought to assess the clinical and oncologic outcomes of robotic-assisted ASFC compared to laparoscopic-assisted ASFC for SFC by undertaking a propensity score-matching analysis.Methods: Seventy patients underwent a robotic-assisted ASFC (n=19) or laparoscopic-assisted ASFC (n=51) to treat SFC from Dec 2015 to Dec 2019. Their data were prospectively collected. The patients were matched at a ratio of 1:1 according to sex, age, body mass index (BMI), comorbidities, the American Society of Anesthesiologists (ASA) score (≤2 or >2), previous abdominal surgeries, and pathologic stage.Results: No statistically significant differences were found between the robotic-and laparoscopic-assisted ASFC groups in relation to operation time, estimated blood loss, length of postoperative hospital stay, time to liquid diet, postoperative complications, tumor size, distal resection margins, histology, lymph node harvest, metastatic lymph nodes, and neuro-vascular invasion. Additionally, no case was converted to a laparotomy. There were no cases readmission or mortality within 30 days of surgery. The distal resection margins were longer in the robotic-assisted ASFC group than the laparoscopic-assisted ASFC group. The robotic-assisted ASFC group had significantly higher operation expenses than the laparoscopic-assisted ASFC group. However, there was no significant difference in the surgical material expenses between the two groups. There were 2 cases of complications in each group; both cases were classified as grade I or II under Dindo's classification of surgical complications.Conclusions: With the exception of operation expenses, robotic-assisted ASFC rivals laparoscopic-assisted ASFC in many respects. ASFC meets the recommended oncological criteria in terms of resection margins and lymph node harvest. We await the results for the long-term oncologic outcomes.

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Colonic splenic flexure carcinoma: is laparoscopic segmental resection a safe enough oncological approach?

Cited by 10 publications

References 20 publications

Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score–weighted Cohort Study

Efficient and Safe Method for Splenic Flexure Mobilization in Laparoscopic Left Hemicolectomy: A Propensity Score–weighted Cohort Study

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

Single-docking robotic-assisted artery-guided segmental splenic flexure colectomy for splenic flexure cancer—a propensity score-matching analysis

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