Laparoscopic-assisted radical left hemicolectomy for colon cancer

Abstract

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...

Safety of anastomotic techniques and consequences of anastomotic leakage in patients with colorectal cancer: a single surgeon experience

“…For stapled methods side to side option should be considered, presenting lower incidence of anastomotic leakage in comparison with end to end type tissue fusion. In a Korean article, Han et al [ 12 ] also opted for SS mechanic fusion of the bowel segments.…”

Intracorporeal Versus Extracorporeal Colo-colic Anastomosis in Minimally-invasive Left Colectomy: a Systematic Review and Meta-analysis

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