Strategy and results of laparoscopic splenic flexure resection for colon cancer

Shigeki Yamaguchi, MD, Toshimasa Ishii, MD, Jo Tashiro, Hiroka Kondo, Asami Suzuki. Saitama Medical University International Medical Center.

Purpose: Splenic flexure colon cancer resection is technically difficult because it is anatomically close to the spleen and the pancreas, also feeding artery is various from the superior mesenteric and the inferior mesenteric artery. This study demonstrates our technique and results.

Technique: First, origin of the inferior mesenteric artery is skeletonized and removed lymph nodes. The left colic artery is divided at the origin and the inferior mesenteric vein is divided in the same part. The mesocolon is mobilized widely as medial to lateral approach. Second, lateral attachment of the sigmoid and descending colon is divided. Lesser sac is opened and the transverse mesocolon is divided at the lower edge of the pancreas. Third, the middle colic artery is skeletonized and lymph nodes are removed. The left branch of the middle colic artery and vein are divided. Occasionally accessory middle colic vessels are confirmed at the left colon. This should be divided at the edge of the pancreas. Forth, the skin is incised, the specimen is extracted and resected. Finally anastomosis and wound closure are performed.

Results: Fifty-three patients underwent splenic flexure resection for colon cancer sice 2007 to March of 2013. Mean age was 67.1, 23 males and 30 females, mean lymph node harvests were 22.2, mean operative time 195 minutes, and mean blood loss was 26g. Dukes’ stage was A: 17, B: 20, C: 14, D: 2. There were 4 recurrence, all patients were Dukes’ C and recurrent part were 3 liver and 1 abdominal wall.

Conclusion: Medial to lateral approach and lymphadenectmy of middle colic and left colic part was safe and effective for colon cancer in splenic flexure.

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