Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography

Iguchi, Kenta; Mushiake, Hajime; Hasegawa, Seiji; Fukushima, Tadao; Numata, Masakatsu; Shiozawa, Manabu; Yukawa, Norio; Rino, Yasushi; Masuda, Munetaka

doi:10.1007/s00384-020-03773-x

Cited by 16 publications

(27 citation statements)

References 21 publications

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“…A total of 16 studies (n = 2203 patients) were included [3,7,8,[14][15][16][17][18][19][20][21][22][23][24][25][26]. Most of the studies were performed in Asia (12 studies, 1923 patients) while the rest were from North America (2 studies, 240 patients); Europe (1 study, 13 patients) and the Middle East (1 study, 27 patients).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…We also noted a significant level of between-study heterogeneity. Further, the official terminology for and definition of the AMCA are not yet standardized [16]. There is need for a global consensus on the terminology for and definition of the AMCA to facilitate determination of the true prevalence of this vessel in future studies.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Surgical anatomy of the accessory middle colic artery: a meta‐analysis with implications for splenic flexure cancer surgery

et al. 2021

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Splenic flexure cancers (SFCs) account for up to 8% of all colon cancers (CCs) [1,2]. Although relatively uncommon, the prognosis for SFC is generally poor, with patients often presenting with colonic obstruction, advanced tumour stages and distant metastasis [1-3]. Surgical resection of CC has traditionally been undertaken viaan open approach [1]. Laparoscopic resection, however, has gained popularity, with randomized clinical trials demonstrating superior short-term outcomes (lower pain scores, reduced blood loss and shorter convalescence) and similar long-term oncological outcomes to open surgery [4][5][6]. Laparoscopic resection of SFC is technically demanding due to the steep learning curve associated with the procedure and the complex regional anatomy characterized by the presence of embryological adhesions, proximity to important organs such as the spleen and pancreas, and a highly heterogeneous

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Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Surgical anatomy of the accessory middle colic artery: a meta‐analysis with implications for splenic flexure cancer surgery

et al. 2021

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“…Splenic flexure veins drain into the IMV in 70%-94% of cases, with 3% draining directly into the splenic vein and 3% into the MCV [27,28]. Lymphatic drainage around the splenic flexure is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long‐term survival

et al. 2022

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Aim:The applicability of laparoscopic D3 oncological resection for splenic flexure cancer (SFC) surgery has not been fully explored due to technical difficulties and variations in surgical procedure. The aim of this work is to describe the feasibility of performing laparoscopic D3 resection in SFC and its impact on long-term survival.Method: A retrospective study on 47 out of 52 consecutive patients who underwent elective laparoscopic colectomy for SFC from December 2006 until December 2019 at Korea University Anam Hospital was performed. Data on patients' demographic and clinical features, surgical procedures, intraoperative and postoperative complications, pathological features and follow-up were collected. Categorical data are expressed as frequencies (n) and percentages (%). Continuous data are expressed as mean ± standard deviation and median (range). The Kaplan-Meier test was used to determine the overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS). Results:The median age of patients was 67.0 years (range 27-87 years) and 72.3% were men. Ten (21.3%) patients presented with an obstructing tumour and underwent an elective laparoscopic colectomy, while 68.1% of patients presented with Stage II and III disease. The conversion rate was 4.3% and the morbidity rate was 31.9%. There was one postoperative death secondary to splenic infarction and anastomotic leak leading to multi-organ failure. Four deaths occurred due to disease progression during a median follow-up of 63.8 months. The rate of recurrence was 20%, the 5-year OS was 89.6% and the 5-year PFS was 72.9%. After R0 resection, the 5-year OS was 91.5% and the 5-year DFS was 74.5%. Conclusion:Laparoscopic D3 colectomy for SFC is feasible, with an acceptable morbidity and long-term oncological outcome when performed by highly skilled laparoscopic colorectal surgeons with knowledge of the complex anatomy around the splenic flexure.Further randomized trials should be performed to determine the advantage of laparoscopic D3 colectomy over conventional colectomy for SFC.

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“…From the patient's left side to the right side, the inferior border of the pancreas was identified, and the mesenteric root was incised, which allowed complete mobilization of the splenic flexure. The IMV passes through the inferior border of the pancreas and usually returns to the splenic or superior mesenteric veins (SMVs) [10, 11]. The IMV was preserved to ensure perfusion of the left colon.…”

Section: Methodsmentioning

confidence: 99%

“…Since the pancreas overhangs ventrally, the dissection continues three‐dimensionally from the caudal to the cranial side to the anterior surface of the pancreas, as if ‘climbing stairs’ to reach the omental bursa. In approximately 30% of cases, the accessory MCA (accMCA) arises from the proximal SMA [11]. In this case, the accMCA is divided at the level of the inferior border of the pancreas at the final stage.…”

Section: Methodsmentioning

confidence: 99%

Novel approach toward minimally invasive surgery for mid‐transverse colon cancer: ‘moving the left colon’ technique

et al. 2023

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AimDuring surgery for mid‐transverse colon cancer (MTC), surgeons often face the dilemma of whether to mobilize the hepatic or splenic flexure. There is no established optimal minimally invasive surgical procedure for MTC.MethodsWe present our novel minimally invasive surgical technique, called the ‘moving the left colon’ technique for MTC, along with a video demonstration. The procedure involves four main steps: (i) mobilization of the splenic flexure using a medial‐to‐lateral approach, (ii) dissection of lymph nodes around the middle colic artery from the left side of the superior mesenteric artery approach, (iii) separation of the pancreas and transverse mesocolon and (iv) ‘moving the left colon’ and performing an intracorporeal anastomosis. By mobilizing the splenic flexure, anatomical landmarks are revealed, which enables safer dissection. Combining this technique with intracorporeal anastomosis allows for a safe and easy anastomosis.ResultsBetween April 2021 and January 2023, a single‐skilled colorectal surgeon performed laparoscopic transverse colectomies using our new approach on three consecutive patients with MTC. The patients had a median age of 75 years (range 46–89 years). The median operative time was 194 min (range 193–228 min) and blood loss was 8 mL (range 0–20 mL). None of the patients experienced any perioperative complications and the median postoperative hospital stay was 6 days.ConclusionWe introduced a novel approach for laparoscopic surgery for MTC. This technique can be performed safely and may help standardize minimally invasive surgery for MTC.

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Evaluation of vascular anatomy for colon cancer located in the splenic flexure using the preoperative three-dimensional computed tomography angiography with colonography

Cited by 16 publications

References 21 publications

Surgical anatomy of the accessory middle colic artery: a meta‐analysis with implications for splenic flexure cancer surgery

Surgical anatomy of the accessory middle colic artery: a meta‐analysis with implications for splenic flexure cancer surgery

Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long‐term survival

Novel approach toward minimally invasive surgery for mid‐transverse colon cancer: ‘moving the left colon’ technique

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