Four cases of laparoscopic colectomy for sigmoid colon and rectal cancer with persistent descending mesocolon

Abstract

Background Persistent descending mesocolon (PDM) is a congenital anomaly associated with the failure of fixation of the descending colon to the lateral abdominal wall. In the laparoscopic colectomy for colorectal cancer, it has been noticed that there are extensive adhesions and a distinctive anatomy of colonic vessels in cases with PDM. Therefore, it is necessary to have sufficient knowledge about PDM so that it can be appropriately treated during surgery. Case presentation Case 1—a 79-year-old man underwent laparoscopic intersphincteric resection for rectal cancer. Preoperative barium enema (BE) revealed that the sigmoid colon was located at the right side of the abdomen. An enhanced computed tomography (CT) showed that the common trunk of the left colic artery (LCA) and the first sigmoid colonic artery (S1) branched from the inferior mesenteric artery (IMA). Case 2—a 68-year-old man underwent laparoscopic sigmoidectomy for sigmoid colon cancer and laparoscopic distal gastrectomy for gastric cancer synchronously. BE showed that the descending colon ran from the splenic flexure to medial caudal side. An enhanced CT showed that the distance from the LCA to the marginal artery was 1.0 cm. Case 3—a 68-year-old man underwent laparoscopic low anterior resection for rectal cancer. BE showed that the descending colon ran to the medial caudal side. An enhanced CT showed that the mesentery of the descending colon was comparatively shortened. Case 4—a 60-year-old man underwent laparoscopic sigmoidectomy for sigmoid colon cancer. An enhanced CT showed that the descending colon ran to the medial caudal side and predicted that the LCA and S1 formed a common trunk and branched radially from the IMA. We reported four cases with PDM recognized preoperatively as above. Three cases had a shortening of the mesocolon. While dissecting the vessels, although special attention was required to maintain the blood flow to the intestine, none of these cases developed any complications during the postoperative course. Conclusions We considered that it is important to have positional awareness of the LCA and the marginal artery to perform the laparoscopic surgery safely when a colorectal cancer with PDM is diagnosed preoperatively using imaging methods.

Persistent Descending Mesocolon as An Intraoperative Risk Factor in Laparoscopic Surgery for Left‐Sided Colon and Rectal Cancer

“…Hence, great care should be taken when dissecting the IMA and LCA because of the possibility of damaging the nearby marginal artery. 8,9 Among the six PDM cases without preservation of the LCA in the present study, anastomotic leakage was seen in one case (case 2) and additional intraoperative resection due to insufficient intestinal blood flow was required in two cases (cases 3 and 9). We assume that these complications were caused by the abnormal vascularization and characteristic adhesions of PDM.…”

“…In these cases, ICG imaging, which enables determination of the adequacy of intestinal blood flow, is useful to decide whether to ligate the LCA. [8][9][10][11] To our knowledge, there are only a few reports comparing laparoscopic colorectal surgery in PDM and non-PDM groups. Wang et al reported that PDM prolonged operative times and increased bleeding during laparoscopic colorectal cancer surgery.…”

“…This is because in cases with a radial pattern IMA, the mesentery of the descending colon is shortened and the marginal artery travels in close proximity to the IMA. Hence, great care should be taken when dissecting the IMA and LCA because of the possibility of damaging the nearby marginal artery 8,9 …”

“…Our experience with this case suggests that dissecting the superior rectal artery while preserving the LCA might help avoid injury to the marginal artery. In these cases, ICG imaging, which enables determination of the adequacy of intestinal blood flow, is useful to decide whether to ligate the LCA 8–11 …”

Laparoscopic Sigmoidectomy for Sigmoid Cancer With Persistent Descending Mesocolon: Anatomical Characteristics and Technical Tips

“…Additionally, the characteristic anatomy makes safe laparoscopic surgery far-fetched. In fact, previous reports suggested that laparoscopic sigmoidectomy carries a high risk of longer operative time and more bleeding [ 4 , 6 ]. The present study aimed to evaluate the feasibility of our mesocolon dissection-first approach utilizing the mesocolon’s anatomical characteristics.…”