Background: Transverse colon cancer resection with lymphadenectomy is relatively difficult. The reasons of this are; 1) there are anatomical varieties of middle colic vessels, 2) the middle colic artery and vein do not run together around their origins, 3) transverse mesocolon attaches with pancreas head and some vein communicate to the pancreas, and so on.
Purpose: To assess the procedure of laparoscopic transverse colon cancer resection with lymphadenectomy.
Procedure: From hepatic flexure to the middle of transverse colon cancer, the right mesocolon is completely mobilized by lateral to medial approach. Also mobilization is continued from the duodenum and pancreas head. In left side transverse colon and splenic flexure cancer, the left mesocolon is mobilized in similar fashion. Confirming cancer location, feeding artery is recognized and this pedicle is grasped and lift up to make sure the origin of vessels. Lymphadenectomy around the vessels and vessel division are performed. At this time careful dissection is necessary according to anatomical fact that the gastrocolic trunk (GCT) is present in approximately 70 %, the colic branch of the GCT is right colic vein and accessory middle colic vein in half and half, double or more middle colic veins are often present.
Results: Transverse colon cancer resection was performed laparoscopically in 40 patients since 2002 to 2006. Actual procedures were transverse colectomy (TC):26, right hemicolectomy (RHC):8, left colectomy (LC):6. Mean operating time and blood loss count were; TC: 209min., 57g, RHC: 223min., 46g, LC: 185min, 22g, respectively. Mean lymph node harvests were; TC: 17.4, RHC: 30.4, LC: 19.2. Mean postoperative hospital stay was; TC: 7.6days, RHC: 7.9, LC: 7.0. Postoperative complications were; TC: 2(wound infection:1, colon perforation: 1), RHC: 1(wound infection), LC: 0.
Conclusion: Laparoscopic transverse colon cancer resection with lymphadenectomy is feasible.
Program Number: P095