Kazuki Ueda, MD, Junichiro Kawamura, MD, Hokuto Ushijima, MD, Koji Daito, MD, Tadao Tokoro, MD, Yoshinori Yane, MD, Yasumasa Yoshioka, MD, Jin-Ichi Hida, MD, Kiyotaka Okuno, MD. Kindai University Faculty of Medicine
The laparoscopic procedure for splenic flexure advanced colon cancer is oncologically difficult to perform. The reasons are including anatomical surrounding the important organs and various variation of dominant vessels. Our indication for advanced colon cancer is almost all cases with the exception of the invasion to surrounding organs. Moreover, to perform adequate lymphadenectomy, we utilized indocyanine green (ICG) fluorescence imaging from October 2016 as a clinical trial (UMIN000025300).
We present the laparoscopic procedure for splenic flexure advanced colon cancer using ICG fluorescence lymphatic flow imaging.
A 0.3ml of ICG (2.5mg/ml) was injected to the submucosal layer around the tumor at one point using 23-gauge localized injection needle under colonoscopy prior to the surgery (one or two days before). During the surgery, the lymphatic flow and lymph nodes (LNs) identified using ICG fluorescence imaging. The lymphadenectomy was performed the laparoscopic conventional fashion proceeding medial to lateral (LNs dissection and vessel ligation), lateral detachment, opening the bursa omentalis and transverse colon take-down.
From January 2005 to December 2017, we experienced 938 cases of colorectal cancers. Among these cases, splenic flexure colon cancer was 61 cases (6.5%). ICG fluorescence imaging during surgery was performed in 8 cases. Except one case, all the case were advanced cancers. In the case with liver metastases, ICG positive (ICG(+)) LNs were failed to detect. The ICG (+) LNs were detectable in the other 7 cases. Of these seven cases, 4 cases were detected alongside the left colic artery and 3 cases were alongside middle colic artery (left branch). Some metastatic LNs were not detected as an ICG (+), but these LNs were included ICG (+) area.
The splenic flexure advanced colon cancer was rare among colon cancer. The ICG fluorescence imaging is detectable lymphatic flow and LNs during laparoscopic surgery. It is helpful to perform adequate lymphadenectomy for colon cancer. In this presentation, we will show the laparoscopic procedure for splenic flexure advanced colon cancer and present the efficacy and the limitation of ICG fluorescence imaging.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93181
Program Number: P364
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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