Minimally invasive surgery for colorectal cancer with persistent descending mesocolon: radiological findings and short-term outcomes

Hanaoka, Marie; Hino, Hitoshi; Shiomi, Akio; Kagawa, Hiroyasu; Manabe, Shoichi; Yamaoka, Yusuke; Kato, Shunichiro; Kinugasa, Yusuke

doi:10.1007/s00464-020-07713-2

Cited by 11 publications

(46 citation statements)

References 11 publications

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“…12 On the other hand, Hanaoka et al reported that the short-term outcomes of laparoscopic colorectal surgery were similar between PDM and non-PDM cases. 13 In our study there were no significant differences in overall postoperative complications between PDM and non-PDM patients, although the operative time tended to be longer in cases that required adhesiolysis and additional resection. A longer operative time led to more ileus in the PDM group, although this was not significant, and may have led to a longer postoperative hospital stay.…”

Section: Discussioncontrasting

confidence: 52%

“…Wang et al reported that PDM prolonged operative times and increased bleeding during laparoscopic colorectal cancer surgery 12 . On the other hand, Hanaoka et al reported that the short‐term outcomes of laparoscopic colorectal surgery were similar between PDM and non‐PDM cases 13 . In our study there were no significant differences in overall postoperative complications between PDM and non‐PDM patients, although the operative time tended to be longer in cases that required adhesiolysis and additional resection.…”

Section: Discussioncontrasting

confidence: 41%

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

Hamada

Sumida

Ozeki

et al. 2021

Asian J Endoscop Surgery

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Introduction Persistent descending mesocolon (PDM) represents a failure of fusion of the descending mesentery, leading to anatomical abnormalities. This study aimed to examine the effects of anatomical features of PDM on laparoscopic surgical outcomes. Methods Patient backgrounds, surgical outcomes, anatomical characteristics, and operative findings were retrospectively compared between 186 patients classified into PDM and non‐PDM groups who underwent primary resection for left‐sided colon and rectal cancer at our hospital from January 2019 to December 2020. Results PDM was diagnosed in nine patients (4.8%). The operative time (337 ± 165 vs 239 ± 107 min, p = 0.010) was significantly different between PDM and non‐PDM groups, but bleeding loss was not different (108 ± 97 ml vs 53 ± 142 ml, p = 0.259). In PDM patients, in addition to abnormal fixation of the sigmoid‐descending colon junction, adhesion of the mesentery of the colon and small intestine in 100%, and adhesion between the mesocolon in 33% patients was confirmed intraoperatively. Ileus was more common in the PDM group (two cases, 22%) and in the non‐PDM group (10 cases, 5.6%), but there was no significant difference in overall postoperative complications between the two groups (p = 0.215). The duration of postoperative hospital stay (28 ± 20 vs 16 ± 11 days, p = 0.002) was significant between the two groups. The left colonic artery (LCA) could not be preserved in six patients in the PDM group, one of whom had anastomotic leakage and two of whom required additional resections due to intraoperative intestinal blood flow failure. Conclusion PDM prolonged operative times and duration of postoperative stay in laparoscopic surgery for left‐sided colon and rectal cancer. Division of the LCA in PDM patients should be considered an intraoperative risk factor for injury to the marginal artery.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussioncontrasting

confidence: 41%

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

Hamada

Sumida

Ozeki

et al. 2021

Asian J Endoscop Surgery

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“…We divided the mesentery, marginal artery, and the main branches from IMA extracorporeally prior to dissection of feeding artery and lymphadenectomy without blood flow impairment of the reconstructed colon. In the cases of colorectal cancer with PDM, a retrospective study suggested that 70% of the inferior mesenteric vein (IMV) and left colic artery were divided extracorporeally, but 5.7% of them were divided extracorporeally [ 5 ]. Therefore, we can dissect the mesentery extracorporeally without touching the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…The shortened mesentery in PDM in a conventional approach carries a higher risk of damage to the essential arteries that maintain the remnant blood flow [ 6 , 9 , 10 ]. Retrospective radiological findings suggested that the median distance between the IMA and the IMV was 14.8 mm and the IMV and the descending colon was 17.2 mm in PDM cases, compared with 23.0 mm and 90.0 mm in non-PDM cases, respectively [ 5 ]. Furthermore, in a typical laparoscopic surgery for colorectal cancer, considering the safeness and oncological aspects, lymphadenectomy and division of vessels were often performed prior to mesenteric dissection with the no-touch isolation technique using conventional medial-to-lateral approach [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, preoperative evaluation for the identification of PDM is also an essential step. Radiological features such as right-shift of the IMA, midline-shift of the descending colon, sigmoid colon located in RLQ, shortened mesentery (between the IMA and IMV or between the IMV and descending colon), and bear-claw IMA have been reported [ 2 , 5 ]. In this case, we identified PDM with atypical artery branches and the location of the sigmoid colon in preoperative CT. A routine preoperative evaluation is sufficient for diagnosis; however, understanding the risk and features of PDM cases is crucial, enabling us to plan the approach in accordance with the PDM while minimizing the complications and maximizing safety [ 5 , 9 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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

Fujiwara¹,

Kaino²

2022

Cureus

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Although rare, persistent descending mesocolon (PDM) is an anatomical anomaly that carries potential risks for laparoscopic colorectal surgery. Impaired blood circulation of the reconstructed colon is especially risky during surgery. We report a case of sigmoid cancer with PDM, in which the patient underwent laparoscopic sigmoidectomy. A 52-year-old man diagnosed with sigmoid cancer was referred to our hospital. PDM was identified with preoperative enhanced-contrast computed tomography, which revealed the sigmoid colon located in the right lower quadrant and a bear-claw inferior mesenteric artery (IMA). Preoperative examination showed cT1N0M0 stage I (Union for International Cancer Control {UICC} eighth). We were not able to identify the branches of IMA after the medial-to-lateral approach. We divided the mesentery and marginal artery and the main branches from IMA extracorporeally prior to lymphadenectomy. Each oral and anal side was dissected without touching the tumor. Then, we marked the line for lymphadenectomy using the dissected line of mesentery as an intracorporeal landmark. Pathological findings showed pT1N0M0 stage I (UICC eighth edition). The patient was discharged without complications. Using this approach and the preoperative recognition of PDM, we performed laparoscopic sigmoidectomy with lymphadenectomy for early-stage PDM case successfully and safely. Our mesocolon dissection-first approach could be a feasible and safer approach for early-stage sigmoid cancer.

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Radiological characteristics and diagnostic clues for persistent descending mesocolon in patients with rectal cancer

Chen,

Huang,

Luo

et al. 2024

Langenbecks Arch Surg

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Minimally invasive surgery for colorectal cancer with persistent descending mesocolon: radiological findings and short-term outcomes

Cited by 11 publications

References 11 publications

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

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

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

Radiological characteristics and diagnostic clues for persistent descending mesocolon in patients with rectal cancer

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