Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes

Kazuki Ueda; Koji Daito; Hokuto Ushijima; Yoshinori Yane; Yasumasa Yoshioka; Tadao Tokoro; Masayoshi Iwamoto; Toshiaki Wada; Yusuke Makutani; Junichiro Kawamura

doi:10.1007/s00464-021-08559-y

Laparoscopic complete mesocolic excision with central vascular ligation for splenic flexure colon cancer: short- and long-term outcomes

Surg Endosc. 2022 Apr;36(4):2661-2670. doi: 10.1007/s00464-021-08559-y. Epub 2021 May 24.

Affiliations

¹ Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan. ueda-k@med.kindai.ac.jp.
² Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osaka Sayama, Osaka, 589-8511, Japan.

Abstract

Background: Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer is an essential procedure for improved oncologic outcomes after surgery. Laparoscopic surgery for splenic flexure colon cancer was recently adopted due to a greater understanding of surgical anatomy and improvements in surgical techniques and innovative surgical devices.

Methods: We retrospectively analyzed the data of patients with splenic flexure colon cancer who underwent laparoscopic CME with CVL at our institution between January 2005 and December 2017.

Results: Forty-five patients (4.8%) were enrolled in this study. Laparoscopic CME with CVL was successfully performed in all patients. The median operative time was 178 min, and the median estimated blood loss was 20 g. Perioperative complications developed in 6 patients (13.3%). The median postoperative hospital stay was 9 days. According to the pathological report, the median number of harvested lymph nodes was 15, and lymph node metastasis developed in 14 patients (31.1%). No metastasis was observed at the root of the middle colic artery or the inferior mesenteric artery. The median follow-up period was 49 months. The cumulative 5-year overall survival and disease-free survival rates were 85.9% and 84.7%, respectively. The cancer-specific survival rate in stage I-III patients was 92.7%. Recurrence was observed in 5 patients (11.1%), including three patients with peritoneal dissemination and two patients with distant metastasis.

Conclusions: Laparoscopic CME with CVL for splenic flexure colon cancer appears to be oncologically safe and feasible based on the short- and long-term outcomes in our study. However, it is careful to introduce this procedure to necessitate the anatomical understandings and surgeon's skill. The appropriate indications must be established with more case registries because our experience is limited.

Keywords: Colorectal surgery; Descending colon cancer; Laparoscopic surgery; Splenic flexure; Surgical outcome; Transverse colon cancer.

MeSH terms

Colectomy / methods
Colon, Transverse* / pathology
Colon, Transverse* / surgery
Colonic Neoplasms* / pathology
Humans
Laparoscopy* / methods
Ligation / methods
Lymph Node Excision / methods
Mesocolon* / pathology
Retrospective Studies
Treatment Outcome