Nagahide Matsubara, MD, PhD, Kiyoshi Tsukamoto, MD, Mie Hamanaka, MD, Masayoshi Kobayashi, MD, Tomoki Yamano, MD, PhD, Masahumi Noda, MD, Naohiro Tomita, MD, PhD
Hyogo College of Medicine
INTRODUCTION: Outcome of the rectal cancer surgery has significantly been improved after the standardization of total mesorectal excision (TME) was introduced. The concept of TME is based on the sharp dissection of anatomical embryological planes, between visceral fascia and parietal plane. This technique allows complete coverage of the cancer specimen and regional lymph nodes as well as the lymphatic drainage with surrounding fat tissue within the mesorectum. Now the same concept has been applied to the colon cancer surgery namely complete mesocolic excision (CME) since embryological planes are not limited to the mesorectal layers. For the maximum oncological outcome, central ligation is also the key technique in addition to the CME. Thus, Our hypothesis of this study is that oncological outcome of laparoscopic left colectomy by CME with central ligation is comparable to the left colectomy by open surgery.
METHOD AND PROCEDURES: We have a long experience of CME for the colon cancer surgery either laparoscopic or open method. Among the laparoscopic colon surgery, descending colon cancer is the technically most demanding since taking down of splenic flexure is the procedure anatomically most distant from the operator and often combined with complex adhesion of gross omentum with possible bleeding from spleen. In order to overcome the week point of lap surgery, we use 3-dimentional CT angiograpy in advance to guide the operation. These vessels must be high tied at the root after dissection of the most distant lymph nodes with complete exposure of the root of the middle colic artery as well as the inferior mesenteric artery. We compare the 3-year survival of both procedures.
RESULTS: With this technique we have achieved the same 3-year survival after laparoscopic and open colorectal surgery with CME with central ligation. We also present our technique of the laparoscopic left coloctomy for the descending colon cancer showing the CME and complete exposure of inferior mesenteric artery with ligation of the root of the left colic artery and the root of the left branch of middle colic artery.
CONCLUSION: We can achieve the comparable oncological outcome of left colectomy by laparoscopic CME with central ligation compared with the open left colectomy.
Session: Poster Presentation
Program Number: P099
