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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2018

01-03-2018

Anatomical and embryological perspectives in laparoscopic complete mesocoloic excision of splenic flexure cancers

Authors: Takeru Matsuda, Yasuo Sumi, Kimihiro Yamashita, Hiroshi Hasegawa, Masashi Yamamoto, Yoshiko Matsuda, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, Yoshihiro Kakeji

Published in: Surgical Endoscopy | Issue 3/2018

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Abstract

Background

Laparoscopic complete mesocoloic excision (CME) with central vascular ligation for splenic flexure cancer is technically challenging because of its anatomical complexity. Although embryological and anatomical consideration should be helpful to perform CME in colorectal cancer surgery, such studies on the splenic flexure are lacking.

Methods

The splenic flexure is located embryologically between the terminal portion of the midgut and the beginning of the hindgut, and is supplied by the superior mesenteric and inferior mesenteric arteries. The mesentery of the transverse and descending colon originally is a continuous sheet, although they rotate and partially fuse to each other during development. Our surgical strategy was excision of the transverse and descending mesocolon with ligation of the left colic artery and left branch of the middle colic artery, and extraction of the specimen in an intact package wrapped by the embryological planes.

Results

We performed laparoscopic surgery according to our surgical strategy in 17 patients with splenic flexure colon cancer. There were no conversions to open surgery or serious intraoperative complications. Two patients had pathological stage (pStage) I, 5 pStage II, 9 pStage III, and 1 pStage IV disease. No patient had recurrence except for 1 with pStage IV cancer, with a median follow-up of 16 months.

Conclusions

Our laparoscopic CME technique is feasible for treatment of splenic flexure cancer. Knowledge of anatomy based on embryology is essential to perform this surgery.
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Metadata
Title
Anatomical and embryological perspectives in laparoscopic complete mesocoloic excision of splenic flexure cancers
Authors
Takeru Matsuda
Yasuo Sumi
Kimihiro Yamashita
Hiroshi Hasegawa
Masashi Yamamoto
Yoshiko Matsuda
Shingo Kanaji
Taro Oshikiri
Tetsu Nakamura
Satoshi Suzuki
Yoshihiro Kakeji
Publication date
01-03-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5792-6

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