Gideon Sroka, MD, MSc, Anan Safadi, MD, Ibrahim Matter, MD. Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel.
Introduction: splenic flexure tumors are rare and compose less than 5% of all colonic tumors. Left hemicolectomy is performed usually as an open procedure due to technical and anatomical difficulties. Totally laparoscopic colon resections have led to better recovery with no oncological compromise. We present here our experience with elective laparoscopic left hemicolectomies for splenic flexure tumors with intra-corporeal anastomosis.
Methods: we retrospectively analysed our prospectively collected database.
Demographic, perioperative and follow up data are presented for those who
went through totally laparoscopic left hemicolectomy (TLLH), and compared with the open technique. Operative technique includes medial to lateral dissection of the meso-colon with high and early vessel ligation, intracorporeal resection and anastomosis with linear stapler. Data is presented as mean±SD.
Results: between 2009-2012 eighteen patients (10/8 F/M) aged 62±12 went through TLLH. Operative time was 132±44 min. EBL was 107±207 cc. Pathological report revealed stage II (T3-4,N0) for 14 patients and Stage III for 4 patients, with 15±5 lymph nodes harvested. No significant differences were found in oncological results with 20 patients who went through the procedure with the open technique. After 28±13 months of follow up 17/18 are alive and disease free.
Conclusions: TLLH is feasible and oncologically safe. The medial approach allows for better recognition and respect of the anatomical planes. Long term results should be compared with open and laparoscopic assisted approaches for better understanding the advantages of this technique.