Kazuki Ueda, MD, Junichiro Kawamura, MD, Koji Daito, MD, Hokuto Ushijima, MD, Tadao Tokoro, MD, Yasumasa Yoshioka, MD, Jin-ichi Hida, MD, Haruhiko Imamoto, MD, Kiyotaka Okuno, MD. Kindai University Faculty of Medicine
Purpose: The laparoscopic procedure for transverse colon cancer (TCC) is technically demanding and its efficacy is controversial. Of those, laparoscopic procedure for TCC at splenic flexure (spTCC) is oncologically more difficult to perform. The reasons are as follows; the incidence rate of spTCC is low, there are important organs surrounding splenic flexure such as duodenum, spleen, pancreas and intricately adhered greater omentum, the recognition of anatomical (surgical) plane is difficult, and feeding vessels are various patterns in this area.
Methods: We prospectively collected data of spTCC patients who underwent laparoscopic left hemicolectomy between January 2005 and December 2015. The perioperative outcomes and oncologic outcomes were assessed. The surgical procedure was as follows. The 5-port technique was utilized for laparoscopic left hemicolectomy. Especially, the umbilical port (a small wound protector and a silicon cap) through the 3.5-cm small umbilical incision was attached and 12-mm and 5-mm trocars were inserted, when starting the operation. The medical-to-lateral approach was suitable for this procedure. The lymph nodes (LNs) dissection had done around the root of IMA, and the LCA was dissected at the root (IMA, SRA preservation) and/or around the root of MCA when necessary. The takedown of splenic flexure to fully mobilization of left colon was mandatory. We performed this from lateral side certainly exposing bursa omentalis and pancreas tail.
Results: TCC were collected in 62 patients (9.6%) of 649 colon cancer patients during study periods. Of those, spTCC was 19 cases (2.9%). Advanced colon cancer was in 17 cases (Tis/T2/T3/T4a=2/4/10/3). Median operation time was 180min. Median estimated blood loss was 20g. The conversion to open procedure was two cases (10.5%). The rate of complications was approximately 15% without anastomotic leakage. A median of 16 LNs were retrieved. Median length of hospital stay was 9 days. Median follow-up period was 289days. One death caused by peritoneal dissemination during this period.
Conclusions: Although the incidence of spTCC is low, our standardized technique gained good perioperative outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79458
Program Number: P209
Presentation Session: Poster (Non CME)
Presentation Type: Poster