Top

BMC Surgery

Published in:

Open Access 01-12-2024 | Colectomy | Research

Unveiling the hidden: identification and management of overlooked blood vessels in laparoscopic left hemicolectomy for splenic flexure cancer

Authors: Wenjun Luo, Peng Chen, Qiang Du, Lie Yang, Zongguang Zhou

Published in: BMC Surgery | Issue 1/2024

Abstract

Background

During laparoscopic left hemicolectomy procedures, a previously overlooked consistently thick blood vessel within the gastrocolic ligament near the splenic hilum may contribute to post-operative bleeding complications. The purpose of this study was to investigate the identification and management of the previously overlooked blood vessel.

Methods

This is a retrospective descriptive study of patients undergoing laparoscopic left colectomy for splenic fexure cancer conducted at a national gastrointestinal surgery centre in China. Consecutive patients with splenic fexure cancer who underwent laparoscopic left colectomy using our“five-step process”(n = 34) between January 2021 and July 2023 were included.

Results

The vessels can be effectively exposed using the aforementioned “five-step process.” It was observed that the overlooked vessels consistently present in all patients were identified as the omental branch of the left gastroepiploic artery and vein.

Conclusion

We have identified the origin of previously overlooked blood vessels and recommended a safe method for their management. This may offer advantages to colorectal surgeons performing laparoscopic left colectomy for splenic flexure cancer

Available only for authorised users

Levien DH, Gibbons S, Begos D, Byrne DW. Survival after resection of carcinoma of the splenic flexure. Dis Colon Rectum. 1991;34(5):401–3. https://doi.org/10.1007/BF02053691.CrossRefPubMed

Nakagoe T, Sawa T, Tsuji T, Jibiki M, Nanashima A, Yamaguchi H, et al. Carcinoma of the splenic flexure: multivariate analysis of predictive factors for clinicopathological characteristics and outcome after surgery. J Gastroenterol. 2000;35(7):528–35. https://doi.org/10.1007/s005350070076.CrossRefPubMed

Shaikh IA, Suttie SA, Urquhart M, Amin AI, Daniel T, Yalamarthi S. Does the outcome of colonic flexure cancers differ from the other colonic sites? Int J Colorectal Dis. 2012;27(1):89–93. https://doi.org/10.1007/s00384-011-1292-7.CrossRefPubMed

de’Angelis N, Espin E, Ris F, Landi F, Le Roy B, Coccolini, et al. Emergency surgery for splenic flexure cancer: results of the SFC study group database. World J Emerg Surgery: WJES. 2021;16(1):20. https://doi.org/10.1186/s13017-021-00365-0.CrossRefPubMedPubMedCentral

de’Angelis N, Hain E, Disabato M, Cordun C, Carra MC, Azoulay D, et al. Laparoscopic extended right colectomy versus laparoscopic left colectomy for carcinoma of the splenic flexure: a matched case-control study. Int J Colorectal Dis. 2016;31(3):623–30. https://doi.org/10.1007/s00384-015-2469-2.CrossRefPubMed

Nakagoe T, Sawai T, Tsuji T, Jibiki M, Ohbatake M, Nanashima A, et al. Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure. Surg Today. 2001;31(3):204–9. https://doi.org/10.1007/s005950170169.CrossRefPubMed

Odermatt M, Siddiqi N, Johns R, Miskovic D, Khan O, Khan J, et al. Short- and long-term outcomes for patients with splenic flexure tumours treated by left versus extended right colectomy are comparable: a retrospective analysis. Surg Today. 2014;44(11):2045–51. https://doi.org/10.1007/s00595-013-0803-2.CrossRefPubMed

de’Angelis N, Martínez-Pérez A, Winter DC, Landi F, Vitali GC, Le Roy B, et al. Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc. 2021;35(2):661–72. https://doi.org/10.1007/s00464-020-07431-9.CrossRefPubMed

Panaccio P, Grottola T, Ricciardiello M, di Sebastiano P, di Mola FF. How we do it: totally laparoscopic complete mesocolon excision for splenic flexure cancer. Langenbeck’s Archives Surg. 2018;403(6):769–75. https://doi.org/10.1007/s00423-018-1699-5.CrossRef

10.

Degiuli M, Reddavid R, Ricceri F, Di Candido F, Ortenzi M, Elmore U, et al. Segmental colonic resection is a safe and effective treatment option for colon cancer of the splenic flexure: a Nationwide retrospective study of the italian society of surgical oncology-colorectal cancer network collaborative group. Dis Colon Rectum. 2020;63(10):1372–82. https://doi.org/10.1097/DCR.0000000000001743.CrossRefPubMed

11.

Manceau G, Alves A, Meillat H, Benhaïm L, Ouaïssi M, Panis YH, et al. What is the Optimal Elective Colectomy for Splenic Flexure Cancer: end of the debate? A Multicenter Study from the GRECCAR Group with a propensity score analysis. Dis Colon Rectum. 2022;65(1):55–65. https://doi.org/10.1097/DCR.0000000000001937.CrossRefPubMed

12.

Garcia-Granero A, Sánchez-Guillén L, Carreño O, Muriel S, Alvarez Sarrado J, Sanfeliu EF, D., et al. Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study. Tech Coloproctol. 2017;21(7):567–72. https://doi.org/10.1007/s10151-017-1663-3.CrossRefPubMed

13.

Murono K, Nozawa H, Kawai K, Sasaki K, Emoto S, Kishikawa J, et al. Vascular anatomy of the splenic flexure: a review of the literature. Surg Today. 2022;52(5):727–35. https://doi.org/10.1007/s00595-021-02328-z.CrossRefPubMed

14.

Wei PL, Huang YJ, Wang W, Huang YM. Comparison of robotic reduced-port and laparoscopic approaches for left-sided colorectal cancer surgery. Asian J Surg. 2023;46(2):698–704. https://doi.org/10.1016/j.asjsur.2022.06.079.CrossRefPubMed

15.

Zhang J, Yang L, Wang Y, Zhou Z. The ‘five-step process’ of laparoscopic left hemicolectomy with the guidance of indocyanine green fluorescence - a video vignette. Colorectal Disease: Official J Association Coloproctology Great Br Irel. 2022;24(8):1015–6. https://doi.org/10.1111/codi.16122.CrossRef

16.

Iino I, Kikuchi H, Suzuki T, Kawabata T, Jindo O, Uno A, et al. Comprehensive evaluation of three-dimensional anatomy of perigastric vessels using enhanced multidetector-row computed tomography. BMC Surg. 2022;22(1):403. https://doi.org/10.1186/s12893-022-01836-0.CrossRefPubMedPubMedCentral

17.

Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric cancer: Official J Int Gastric Cancer Association Japanese Gastric Cancer Association. 2021;24(1):1–21. https://doi.org/10.1007/s10120-020-01042-y.CrossRef

18.

Andersen BT, Stimec BV, Kazaryan AM, Rancinger P, Edwin B, Ignjatovic D. Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models, part II: anatomy of relevance to surgeons operating splenic flexure cancer. Surg Endosc. 2022;36(12):9136–45. https://doi.org/10.1007/s00464-022-09394-5.CrossRefPubMedPubMedCentral

19.

Tanaka T, Matsuda T, Hasegawa H, Yamashita K, Nakamura T, Suzuki S, et al. Arterial anatomy of the splenic flexure using preoperative three-dimensional computed tomography. Int J Colorectal Dis. 2019;34(6):1047–51. https://doi.org/10.1007/s00384-019-03289-z.CrossRefPubMed

20.

Karatay E, Javadov M. The importance of the Moskowitz artery as a lesser-known collateral pathway in the medial laparoscopic approach to splenic flexure mobilisation and its evaluation with preoperative computed tomography. Wideochirurgia i inne Techniki Maloinwazyjne = Videosurgery Other Miniinvasive Techniques. 2021;16(2):305–11. https://doi.org/10.5114/wiitm.2020.100826.CrossRefPubMed

21.

Kim H, Youn KH, Kim YS. Anatomical classification of middle rectal arteries regarding detailed vasculature patterns. Anat cell Biology. 2022;55(2):118–23. https://doi.org/10.5115/acb.22.010.CrossRef

22.

Ogi Y, Egi H, Ishimaru K, Koga S, Yoshida M, Kikuchi S, et al. Cadaveric and CT angiography study of vessels around the transverse colon mesentery. World J Surg Oncol. 2023;21(1):36. https://doi.org/10.1186/s12957-023-02919-9.CrossRefPubMedPubMedCentral

Title: Unveiling the hidden: identification and management of overlooked blood vessels in laparoscopic left hemicolectomy for splenic flexure cancer
Authors: Wenjun Luo
Peng Chen
Qiang Du
Lie Yang
Zongguang Zhou
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Colectomy
Colectomy
Hemicolectomy
Hemicolectomy
Published in: BMC Surgery / Issue 1/2024
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-024-02424-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Unveiling the hidden: identification and management of overlooked blood vessels in laparoscopic left hemicolectomy for splenic flexure cancer

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Stapled versus hand-sewn anastomoses after bowel resection in patients with crohn disease

Open surgery with a lateral neck approach in cases of foreign body impaction that penetrating the neck through the esophagus: a single-center experience

Risk factors on surgical compliance and its impact on survival outcomes in meningioma patients: a SEER-based retrospective propensity-score matched analysis

Initial experience of 3-dimensional exoscope in decompression of massive lumbar disc herniation

Effects of preoperative surgeon warm-up in video-assisted thoracoscopic surgery lobectomy

Optimising surgical anastomosis in ileocolic resection for Crohn’s disease with respect to recurrence and functionality: two international parallel randomized controlled trials comparing handsewn (END-to-end or Kono-S) to stapled anastomosis (HAND2END and the End2End STUDIES)