Laparoscopic resection with intracorporeal anastomosis for colon carcinoma located in the splenic flexure

Ceccarelli, Graziano; Biancafarina, Alessia; Patriti, Alberto; Spaziani, Alessandro; Bartoli, Alberto; Bellochi, Raffaele; Codacci-Pisanelli, Massimo; Casciola, Luciano

doi:10.1007/s00464-009-0853-0

Cited by 33 publications

(19 citation statements)

References 12 publications

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“…A mini-invasive approach proved to be especially suitable for splenic flexure mobilizing; due to its fixed position, some Authors suggested the use of Da Vinci system for this subgroup of colic cancer. Effectively, laparoscopic robot-assisted resection seems to be a promising approach for splenic flexure cancer treatment, since it allows finer manipulation which can decrease the risk of spleen injury [ 15 ]. Anastomosis is generally side-to-side performed.…”

Section: Discussionmentioning

confidence: 99%

“…A fast track protocol was performed in these patients, with good outcome in term of short terms complications and with shorter hospital stay. Preservation of inferior mesenteric and middle colic arteries could account for the good anastomotic healing, much more than improved experience with this technique [ 15 ]. Attemping to answer to all these controversies, we believe that when laparoscopic splenic flexure resection is performed after an adequate learning curve regarding other colon cancer locations, and if it is performed on appropriate patient groups with accurate preoperative diagnosis, this procedure should be considered a safe and useful treatment [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic colonic resection for splenic flexure cancer: our experience

et al. 2015

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Laparoscopic colonic resection for splenic flexure cancer: our experience

et al. 2015

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“…It has studied earlier by Griffith et al, demonstrated anatomical description of colon blood supply in 100 cadavers, revealed that splenic flexure colon supplied by LCA in 89% of cases and 11% by MCA. 12 As lympahtic spread will follow arterial system in their drainage. 13 Therefore, SFC carcinoma has dual lymphatic drainage: to the superior mesenteric vessel and to the inferior mesenteric vessels.…”

Section: Resultsmentioning

confidence: 99%

Splenic flexure cancer optimum level of vessel ligation

Rao¹,

Reddy²,

Chilukoti³

2017

Int Surg J

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Background: Incidence of splenic flexure carcinoma is very low in colorectal cancer but often time presented in an advanced stage with high risk of obstruction, contributing poor prognosis. Aim of the study was to investigate the adequacy of vessel ligation in SFC in term of overall survival.Methods: 35 patients diagnosed with splenic flexure carcinoma enrolled and analyzed, patients categorized based on the level of vessel ligation as group-A, left branch of middle colic (LMA) and left colic artery division (LCA) compared, group-B, LCA and marginal of middle colic artery (MMC).Results: CEA marker was not significantly changed post-operatively, as it was within normal range preoperatively at an average of 9-12 µg/ml. There is no significance in staging of tumors in all stages, and recurrence of tumor is present in 5 in group A. Radical margins both proximal and distal ends are not significant. Tumor clearance achieved successfully in both arms in term of proximal margin achieved at 7.9±3.5cm in groups B and 8.3±4.1 cm in group A, p = 0.312. Distal margin reported at 8.7±4.1 cm and 8.9±3.98cm, p = 0.58, respectively. Lymph nodes are positive in group-A and group-B without any significance. Tumor size or diameter ranging from 5.1±3.1 in group-A and 4.76±3.8 in group-B. According to the cell differentiation, majority of the tumor grade turned out to be moderately differentiated cancer, rated at 14 patients (40.1%) in group A and 13 patients (37.1%) in group B. one patients found to be well or poorly differentiated cell tumors in group-A. Overall p-values were insignificant in regards tumor cell differentiation in both groups, p = 0.213. Incidence of lympho-vascular invasion reached only 3 (8.5%) vs. 4 patients (11.2%), p = 0.562, in A and B group.Conclusions: Higher level of vessel ligation has no added significance in overall outcome, but has role to lower the risk of recurrence rate in Splenic flexure carcinoma patients.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted radical left hemicolectomy for colon cancer

Han¹,

Min²

2016

J. Vis. Surg.

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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...

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Laparoscopic resection with intracorporeal anastomosis for colon carcinoma located in the splenic flexure

Abstract: Laparoscopic partial resection seems to be feasible and safe for the treatment of early-stage and locally advanced SF cancer.

Cited by 33 publications

References 12 publications

Laparoscopic colonic resection for splenic flexure cancer: our experience

Laparoscopic colonic resection for splenic flexure cancer: our experience

Splenic flexure cancer optimum level of vessel ligation

Laparoscopic-assisted radical left hemicolectomy for colon cancer

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