Laparoscopic Surgery to Locally Advance Colon Cancer Invading to Adjacent Urinary Structures

Yosuke Fukunaga, MD, PhD, Masashi Ueno, Satoshi Nagayama, YoshiyaT Fujimoto, Tsuyoshi Konishi, Takashi Akiyoshi, Toshiya Nagasaki, Jun Nagata, Yukiharu Hiyoshi, Hisanori Miki, Atsushi Ogura, Shunsuke Hamasaki, Hiromichi Fukuoka, Yuzo Fukuda. Cancer Institute Hospital

While recent development and penetration of the laparoscopic colorectal surgery, magnification of high quality optics plays an important role to achieve high level of curability as well as less invasiveness. We retrospectively investigated feasibility of laparoscopic surgery to locally advance colon cancer invading to adjacent urinary structures.

Nineteen cases of colon cancer invading to adjacent urinary structures by preoperative diagnostic modalities were treated by laparoscopic operation since 2010 in our hospital.  The patients in whom the primary tumor invaded to full thickness of the urinary bladder underwent lymph node dissection and colonic mobilization in laparoscopically and partial resection of the urinary bladder in direct vision via Phannestiel transverse skin incision just above the pubic bonne.  In patients in whom the both urinary orifices were invaded, total cystectomy associated with the primary cancer was performed in laparoscopically.  In patients in whom the ureter was invaded by the primary cancer, reconstruction of the ureter was performed in end-to-end anastomosis or interposition of the ileum in laparoscopically.

Results: There were 2 open conversions (12%).   The median operation time and estimated blood loss was 345 min and 85 g, respectively.  There were 5 postoperative complications (wound infection in 2, small bowel obstruction in 2, and urinary retention in 1 case).  No mortality was encountered.  All 19 cases were pathologically proved of negative for cancer on the excisional surface of the specimen.

Conclusions: A surgeon should obtain urological specific techniques in laparoscopically when treating to locally advance colon cancer invading to the adjacent urinary structures.  Once they know how to mobilize the urinary bladder and how to reconstruct the ureter via laparoscopy, this radical laparoscopic operation may be feasible on the basis of less blood loss with less postoperative mobility.