David M Schwartzberg, MD1, Hermann Kessler, MD, PhD2. 1New York University Langone Health, 2Cleveland Clinic Foundation, Ohio
Ulcerative colitis (UC) is a chronic mucosal inflammatory bowel disease of the colon and rectum. After 10 years of having the disease, there is a significant risk of dysplasia or cancer in the affected colorectum, and because of the often aggressive biology of these tumors, frequent endoscopic surveillance is warranted. Over a third of patients with UC will ultimately require an operation, and although for specfic cases alternative operations can be pursued, most patients perfer an ileal pouch-anal anastomosis (IPAA) with J-pouch construction. A staged IPAA removes the affected colon and rectum treating UC and also restores intestinal continuity. However, the the standard colectomy for UC includes low ligations of the main colonic vascular pedicle branches (ileocolic, right colic, middle colic and inferior mesenteric) that does not address a proper oncologic operation. A high ligation of the named vessels as well as a proper resection of the affected colon with its mesentery and lymph node package are needed to treat colon cancer. Analogous to a total mesorectal exicision for rectal cancer, a more radical procedure to remove the tumor and lymph node packet for colon cancer is described as a complete mesocolic exision (CME) in efforts to increase disease free survival. We demonstrate a laparoscopic subtotal colectomy for UC, with an oncologic complete mesocolic excision for an hepatic flexure carcinoma in the setting of chronic mucosal inflammation secondary to chronic UC as the first procedure in a 3-staged IPAA.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93745
Program Number: V021
Presentation Session: Colorectal Videos I
Presentation Type: Video
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