Laparoscopic colonic resection for splenic flexure cancer: our experience

Abstract

BackgroundThe treatment of colon cancer located in splenic flexure is not standardized. Laparoscopic approach is still considered a challenging procedure. This study reviews two Institutions experience in laparoscopic treatment of left colonic flexure cancer. Intraoperative, pathologic and postoperative data from patients undergoing laparoscopic splenic flexure resection were analyzed to assess oncological safety as well as early and medium-term outcomes.MethodsFrom October 2005 to May 2014 laparoscopic splenic flexure resection was performed in 23 patients.ResultsConversion rate was nihil. In 7 cases the anastomosis was performed intracorporeally. Specimen mean length was 21.2 cm, while the distance of distal and proximal resection margin from tumor site was 6.5 and 11.5 respectively. The mean number of harvested lymph nodes was 20.8. Mean operative time was 190 min and mean estimated blood loss was equal to 55 ml. As regard major postoperative complications, one case of postoperative acute pancreatitis and one case of postoperative bleeding from the anastomotic suture line were reported.ConclusionsAlthough our experience is limited and appropriate indications must be set by future randomized studies, we believe that laparoscopic resection with intracorporeal anastomosis appears feasible and safe for patients affected by splenic flexure cancer.

Robotic left colectomy with complete mesocolectomy for splenic flexure and descending colon cancer, compared with a laparoscopic procedure

“…A previous meta‐analysis did not demonstrate an advantage for open colectomy compared with a laparoscopic approach for T4 colon cancers in terms of oncologic outcome . Postoperative recovery and complications did not differ between the R‐LCCM and L‐LCCM groups, with values seen to be in a similar range to those found in previous studies …”

“…Previous studies provide support for our approach to arterial ligation on the basis of the anatomical validity, informing the majority of metastatic lymph nodes of SF‐DCC to be distributed along the paracolic arcade and left colic artery, rarely along the middle colic artery and its left branch . The mean number of lymph nodes harvested did not differ between the R‐LCCM and L‐LCCM groups, and the value ranked in the upper range of that seen in previous SFC studies using a laparoscopic approach . The IMV was excised at its root in a case when a sufficient mobility of proximal colon was needed.…”

“…We implemented extracorporeal anastomosis mostly by the side‐to‐end or side‐to‐side approach. Although most previous studies suggest extracorporeal anastomosis, entirely intra‐abdominal resection and anastomosis is increasingly adopted in laparoscopic colon surgery . Splenectomy was not required in our patients because tumour invasion or injury was not seen in the study cohort.…”

“…However, among laparoscopic colorectal procedures, splenic flexure resection and transverse colectomy were considered to be the most difficult in a survey of experienced laparoscopic colorectal surgeons . Several laparoscopic techniques have been used for splenic flexure cancer (SFC), while few data are available for robotic approaches aside from a single technical report …”

“…11 However, among laparoscopic colorectal procedures, splenic flexure resection and transverse colectomy were considered to be the most difficult in a survey of experienced laparoscopic colorectal surgeons. 12 Several laparoscopic techniques have been used for splenic flexure cancer (SFC), [13][14][15][16][17] while few data are available for robotic approaches aside from a single technical report. 18 Robotic approaches are increasingly used in colorectal surgery owing to their greater visualization of the surgical site and a high degree of dexterity.…”