Techniques and feasibility of the cranial‐to‐caudal approach for laparoscopic left colectomy in obstructive splenic flexure cancers: A consecutive case series (with video)

Göksoy, Beslen

doi:10.1111/codi.16265

Cited by 3 publications

(1 citation statement)

References 22 publications

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“…Since anatomical variations of the vasculature at splenic exure by left colic artery (LCA) and middle colic artery (MCA) remain ambiguous [4], surgery for splenic exure cancers is one of the most challenging operations among other colorectal surgical procedures [5]. Splenic exure colon, located between the right and left colon, received a dual vascular supply of both superior mesenteric vessels and inferior mesenteric vessels.…”

Section: Introductionmentioning

confidence: 99%

Extended Procedure Has No Oncological Benefits over Segmental Resection in the Treatment of Non-metastatic Splenic Flexure Colon Cancer, a Population-Based Cohort Study

Wang

Zheng

Chen

et al. 2023

Preprint

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AIM: To compare the oncological survival outcome between extended resections and segmental resection for non-metastatic splenic flexure tumors. METHODS: A total of 10063 splenic flexure colon cancers patients who underwent extended resection (n=5546) or segmental resection (n=4517) from 2010 to 2018 were included from the Surveillance, Epidemiology, and End Results (SEER)-registered database. Survival rates were compared between groups. To reduce the inherent bias of retrospective studies, propensity score matching (PSM) analysis was performed. RESULTS: Patients from the extended resection group had higher pT stage, pN stage, larger tumor size, and higher rates of elevated CEA level, perineural invasion, and tumor deposits than those from the segmental resection group (each P<0.05). The 5-year CSS rate was slightly lower in extended resection patients than that in segmental resection patients (79.2% vs. 81.6%, P =0.002), while the 5-year OS were comparable between groups (66.2% vs. 66.9%, P =0.513). After the PSM performed, both the 5-year CSS and 5-year OS rates in extended resection group and segmental resection group were comparable (5-year CSS: 84.9% vs. 83.0%, P =0.577; 5-year OS: 70.6% vs. 66.0%, P =0.415). These findings were similar in the subgroup analysis that included only patients with stage III disease or with tumor size ≥ 7 cm. In addition, although the number of harvested lymph nodes was larger in the extended resection group compared to the segmental resection group (12.7 vs. 14.4, P<0.001), the numbers of invaded lymph nodes remained similar between groups (0.5 vs. 0.5, P=0.90). CONCLUSION: Extended procedures have no significant oncological benefits over segmental resection in the treatment of non-metastatic splenic flexure colon cancer, even for locally advanced cases. The larger number of harvested lymph nodes in the extended resection group did not confer any advantage relative to segmental resection with regard to CSS, since it was not associated with an increase in the number of invaded lymph nodes harvested.

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Section: Introductionmentioning

confidence: 99%

Extended Procedure Has No Oncological Benefits over Segmental Resection in the Treatment of Non-metastatic Splenic Flexure Colon Cancer, a Population-Based Cohort Study

Wang

Zheng

Chen

et al. 2023

Preprint

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Extended procedure has no oncological benefits over segmental resection in the treatment of non-metastatic splenic flexure colon cancer, a population-based cohort study and a single center’s decade-long experience

Wang,

Zheng

et al. 2024

Updates Surg

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CC vs. CC-Plus: A Comparison between Two Cranial-to-Caudal Approaches for Laparoscopic Right Hemicolectomy: A Single-Center Retrospective Study

Jiao,

Mongardini,

Xie

et al. 2024

JPM

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Background: Colorectal cancer is a leading cause of cancer-related deaths worldwide, with approximately 1.9 million new cases and over 935,000 deaths in 2020. Right-sided colon cancer, a subset of colorectal cancer, represents a significant health burden. Laparoscopic colon surgery has significantly improved postoperative recovery. The superiority of one approach or landmark over another is still argued about due to the lack of large-scale prospective studies. However, deep understanding both of the anatomical variation and characteristics of each approach is of extreme importance to minimizing adverse effects and maximizing patient benefit after laparoscopic right hemicolectomy. Among these, the cranial-to-caudal approach offers advantages such as reduced intraoperative blood loss, shorter operation time, and decreased risk of vascular injury. The purpose of this study is to compare the efficacy and safety of two cranial-to-caudal approaches for laparoscopic right hemicolectomy (LRH). Specifically, the study aims to evaluate the differences between the conventional cranial-to-caudal approach with medial ligation of the middle colic vein (MCV), and the cranial-to-caudal approach with cranial MCV ligation and surgical trunk sheath opening (CC-plus). The goal is to determine which method offers superior outcomes in terms of intraoperative blood loss, operation time, and overall patient recovery. Materials and Methods: This single-center retrospective study compared two cranial-to-caudal approaches for LRH. The study included 51 patients who underwent LRH between January 2021 and November 2023 at the Second Affiliated Hospital, Zhejiang University School of Medicine. Patients were divided into two groups: Group A (26 patients) used the cranial-to-caudal approach with medial ligation of the middle colic vein (MCV), and Group B (25 patients) used the cranial-to-caudal approach with cranial MCV ligation and surgical trunk sheath opening (CC-plus). General characteristics, intraoperative parameters, and postoperative outcomes were compared. Statistical analysis was performed using SPSS version 20.0, with significance set at p < 0.05. Results: There were no significant differences between the groups regarding age, gender, tumor location, or clinical staging. All patients achieved R0 resection with no perioperative deaths. The CC-plus group had significantly reduced intraoperative blood loss and shorter operation time compared to the CC group (p < 0.05). No significant differences were found in first postoperative exhausting time, first postoperative defecation time, and postoperative hospital stay between the two groups. Furthermore, no significant differences were evaluated in postoperative complications (surgical site infection (SSI), ileus or bowel obstruction, refractory diarrhea, anastomotic leakage, deep vein thrombosis (DVT), hemorrhage) between the two groups on a median follow up of 12.6 months. Pathological examination showed no significant differences in total lymph nodes dissected and tumor stage. Conclusions: The cranial-to-caudal approach with MCV ligation via the cranial approach (CC-plus) is a safe and effective method for LRH, offering advantages in terms of reduced operation time and intraoperative blood loss. This study’s findings suggest that the CC-plus approach may be superior to the conventional cranial-to-caudal approach.

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Techniques and feasibility of the cranial‐to‐caudal approach for laparoscopic left colectomy in obstructive splenic flexure cancers: A consecutive case series (with video)

Cited by 3 publications

References 22 publications

Extended Procedure Has No Oncological Benefits over Segmental Resection in the Treatment of Non-metastatic Splenic Flexure Colon Cancer, a Population-Based Cohort Study

Extended Procedure Has No Oncological Benefits over Segmental Resection in the Treatment of Non-metastatic Splenic Flexure Colon Cancer, a Population-Based Cohort Study

Extended procedure has no oncological benefits over segmental resection in the treatment of non-metastatic splenic flexure colon cancer, a population-based cohort study and a single center’s decade-long experience

CC vs. CC-Plus: A Comparison between Two Cranial-to-Caudal Approaches for Laparoscopic Right Hemicolectomy: A Single-Center Retrospective Study

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