Kenji Baba, MD, PhD, Shinichiro Mori, MD, PhD, Yoshiaki Kita, MD, PhD, Kan Tanabe, MD, Tetuya Ijichi, MD, Masayuki Yanagi, MD, Yasuto Uchikado, MD, PhD, Hiroshi Kurahara, MD, PhD, Yoshikazu Uenosono, MD, PhD, Yuko Mataki, MD, PhD, Masahiko Sakoda, MD, PhD, Akihiro Nakajo, MD, PhD, Kosei Mawmura, MD, PhD, Shoji Natsugoe, MD, PhD. Kagoshima University
OBJECTIVE: Laparoscopic colonic resection is increasingly regarded as the gold standard fof benign and malignant colonic lesions.
Laparoscopic assisted colectomy for colon cancer with an extracorporeal anastomotic technique is the standard technique.
However the extracorporeal anastomosis technique requires the relatively large wound and mobilization of colon, due to extract colon and mesenterium.
The aim of this study was to evaluate safety and feasibility of intracorporeal anastomosic (IA) technique in laparoscopic colectomy for Stage I colon cancer.
METHODS: Between May 2015 and July 2016 at Kagoshima University Hospital, six patients who underwent IA in laparoscopic colectomy were included (1 male and 5 female, age: 61.5 (range 50-67) years old, body mass index of 22.6 (range 19-25)).
The outcomes were evaluated in terms of operation time, intraoperative blood loss, length of postoperative hospital stay and perioperative complications.
SUGICAL PROCEDURES: The patients were placed in the supine position under general anesthesia. Five trocars were inserted in the abdomen, maintaining pneumoperitoneum at 10 mmHg with carbon dioxide.
A 10mm flexible laparoscope was inserted from the umbilical port. After exploring abdominal cavity, colon cancer was identified.
Then the medial-to lateral dissection technique was performed with minimum mobilization of olon in all cases. The targeted nutrient arteries were identified and dissected.
After transection of colon or ileum with 60-mm endostapler, the anastomosis was fashioned. Functional end-to-end anastomosis was created with a 60-mm endostapler, and the enterotomy was closed with endstapler or continuous suture of V-Loc.
The specimen was extracted through an umbilical incision which was required minimun size using EndoBags.
RESULTS: Intracorporeal anastomosis in laparoscopic colectomy for Stage I colon cancer was performed for six patients with 1 ascending colon cancer, 2 transverse colon cancer, 1 descending colon cancer and 2 sigmoid colon cancer.
Tumor stage in pathological diagnosis was all stage I (4 T1 tumors and 2 T2 tumors).
The mean operative time was 306 minutes, the mean blood loss was 40 ml. The mean length of postoperative hospital stay was 12 days. There were no intraoperative complications and no conversion to open surgery. One patient experienced postoperative complication which was ileus of grade 2 according to the Clavien-Dindo classification. There were no 30-day mortality.
CONCLUSION: Intracorporeal anastomosis technique in laparoscopic colectomy for Stage I colon cancer is a safe and feasible procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79835
Program Number: P217
Presentation Session: Poster (Non CME)
Presentation Type: Poster