Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 2/2017

01-02-2017 | Original Article

Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging

Authors: Jun Watanabe, Mitsuyoshi Ota, Yusuke Suwa, Atsushi Ishibe, Hidenobu Masui, Kaoru Nagahori

Published in: International Journal of Colorectal Disease | Issue 2/2017

Login to get access

Abstract

Purpose

The treatment of splenic flexural colon cancer is not standardized because the lymphatic drainage is variable. The aim of this study is to evaluate the lymph flow at the splenic flexure.

Methods

From July 2013 to January 2016, consecutive patients of the splenic flexural colon cancer with a preoperative diagnosis of N0 who underwent laparoscopic surgery were enrolled. Primary outcome is frequency of the direction of lymph flow from splenic flexure. We injected indocyanine green (2.5 mg) into the submucosal layer around the tumor and observed lymph flow using the laparoscopic near-infrared camera system in 30 min after injection.

Results

Thirty-one patients were enrolled in this study. The lymph flow was visualized in 31 patients (100 %) without any complications. No case exhibited lymph flow in both the left colic artery (LCA) and left branch of the middle colic artery (lt-MCA) areas. There were 19 cases (61.3 %) with lymph flow directed to the area of the root of the inferior mesenteric vein (IMV), regardless of the presence of the left accessory aberrant colic artery. Lymph node metastases were observed in six cases (19.4 %), and all of the involved lymph nodes existed in lymph flow areas determined by real-time indocyanine green fluorescence imaging.

Conclusions

The findings of the lymph flow pattern of splenic flexure suggest that lymph node dissection at the root of the IMV area is important, and it may be not necessary to ligate both the lt-MCA and LCA, at least in cases without widespread lymph node metastases.
Literature
1.
The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059CrossRef
2.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMed
3.
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–484CrossRefPubMed
4.
Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260(1):23–30CrossRefPubMed
5.
Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(1):44–52CrossRefPubMed
6.
Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645CrossRefPubMed
7.
Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248(1):1–7CrossRefPubMed
8.
West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28(2):272–278CrossRefPubMed
9.
West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30(15):1763–1769CrossRefPubMed
10.
Pisani Ceretti A, Maroni N, Sacchi M, Bona S, Angiolini MR, Bianchi P, Opocher E, Montorsi M (2015) Laparoscopic colonic resection for splenic flexure cancer: our experience. BMC Gastroenterol 15:76CrossRefPubMedPubMedCentral
11.
Perrakis A, Weber K, Merkel S, Matzel K, Agaimy A, Gebbert C, Hohenberger W (2014) Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations. Int J Color Dis 29(10):1223–1229CrossRef
12.
Nakagoe T, Sawai T, Tsuji T, Jibiki M, Ohbatake M, Nanashima A, Yamaguchi H, Yasutake T, Kurosaki N, Ayabe H, Ishikawa H (2001) Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure. Surg Today 31(3):204–209CrossRefPubMed
13.
Nakagoe T, Sawa T, Tsuji T, Jibiki M, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H, Ishikawa H (2000) Carcinoma of the splenic flexure: multivariate analysis of predictive factors for clinicopathological characteristics and outcome after surgery. J Gastroenterol 35(7):528–535CrossRefPubMed
14.
Steffen C, Bokey EL, Chapuis PH (1987) Carcinoma of the splenic flexure. Dis Colon rectum 30(11):872–874
15.
Khafagy MM, Stearns MW Jr (1973) Carcinoma of the splenic flexure. Dis Colon rectum 16(6):504–507
16.
17.
Rusu MC, Vlad M, Voinea LM, Curca GC, Sisu AM (2008) Detailed anatomy of a left accessory aberrant colic artery. Surg Radiol Anat 30(7):595–599CrossRefPubMed
18.
Mieog JS, Troyan SL, Hutteman M, Donohoe KJ, van der Vorst JR, Stockdale A, Liefers GJ, Choi HS, Gibbs-Strauss SL, Putter H, Gioux S, Kuppen PJ, Ashitate Y, Lowik CW, Smit VT, Oketokoun R, Ngo LH, van de Velde CJ, Frangioni JV, Vahrmeijer AL (2011) Toward optimization of imaging system and lymphatic tracer for near-infrared fluorescent sentinel lymph node mapping in breast cancer. Ann Surg Oncol 18(9):2483–2491CrossRefPubMedPubMedCentral
19.
Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2013) The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc 27(8):3003–3008CrossRefPubMed
20.
Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ (2015) Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 220(1):82–92 e81CrossRefPubMed
21.
Kudszus S, Roesel C, Schachtrupp A, Hoer JJ (2010) Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage. Langenbeck’s Arch Surg 395(8):1025–1030CrossRef
22.
Nishigori N, Koyama F, Nakagawa T, Nakamura S, Ueda T, Inoue T, Kawasaki K, Obara S, Nakamoto T, Fujii H, Nakajima Y (2016) Visualization of lymph/blood flow in laparoscopic colorectal cancer surgery by ICG fluorescence imaging (lap-IGFI. Ann Surg Oncol 23(Suppl 2):266–274CrossRef
23.
Sherwinter DA, Gallagher J, Donkar T (2013) Intra-operative transanal near infrared imaging of colorectal anastomotic perfusion: a feasibility study. Color Dis 15(1):91–96CrossRef
24.
Aldridge MC, Phillips RK, Hittinger R, Fry JS, Fielding LP (1986) Influence of tumour site on presentation, management and subsequent outcome in large bowel cancer. Br J Surg 73(8):663–670CrossRefPubMed
25.
Mori T, Kimura T, Kitajima M (2010) Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol 19(1):18–23CrossRefPubMed
26.
27.
Korn JM, Tellez-Diaz A, Bartz-Kurycki M, Gastman B (2014) Indocyanine green SPY elite-assisted sentinel lymph node biopsy in cutaneous melanoma. Plast Reconstr Surg 133(4):914–922CrossRefPubMed
28.
Reuthebuch O, Haussler A, Genoni M, Tavakoli R, Odavic D, Kadner A, Turina M (2004) Novadaq SPY: intraoperative quality assessment in off-pump coronary artery bypass grafting. Chest 125(2):418–424CrossRefPubMed
29.
Nagata J, Fukunaga Y, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Yamamoto N, Ueno M (2016) Colonic marking with near-infrared, light-emitting, diode-activated indocyanine green for laparoscopic colorectal surgery. Dis Colon rectum 59(2):e14–e18
30.
Cahill RA, Anderson M, Wang LM, Lindsey I, Cunningham C, Mortensen NJ (2012) Near-infrared (NIR) laparoscopy for intraoperative lymphatic road-mapping and sentinel node identification during definitive surgical resection of early-stage colorectal neoplasia. Surg Endosc 26(1):197–204CrossRefPubMed
31.
Doekhie FS, Peeters KC, Kuppen PJ, Mesker WE, Tanke HJ, Morreau H, van de Velde CJ, Tollenaar RA (2005) The feasibility and reliability of sentinel node mapping in colorectal cancer. Eur J Surg Oncol 31(8):854–862CrossRefPubMed
32.
Des Guetz G, Uzzan B, Nicolas P, Cucherat M, de Mestier P, Morere JF, Breau JL, Perret G (2007) Is sentinel lymph node mapping in colorectal cancer a future prognostic factor? A meta-analysis. World J Surg 31(6):1304–1312CrossRefPubMed
33.
van der Pas MH, Meijer S, Hoekstra OS, Riphagen II, de Vet HC, Knol DL, van Grieken NC, Meijerink WJ (2011) Sentinel-lymph-node procedure in colon and rectal cancer: a systematic review and meta-analysis. Lancet Oncol 12(6):540–550CrossRefPubMed
34.
Kelder W, Braat AE, Karrenbeld A, Grond JA, De Vries JE, Oosterhuis JW, Baas PC, Plukker JT (2007) The sentinel node procedure in colon carcinoma: a multi-centre study in The Netherlands. Int J Color Dis 22(12):1509–1514CrossRef
Metadata
Title
Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging
Authors
Jun Watanabe
Mitsuyoshi Ota
Yusuke Suwa
Atsushi Ishibe
Hidenobu Masui
Kaoru Nagahori
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 2/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-016-2669-4

Other articles of this Issue 2/2017

International Journal of Colorectal Disease 2/2017 Go to the issue

Original Article

Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery—initial experience with a new operation approach

Original Article

Pathologic response grade after long-course neoadjuvant chemoradiation does not influence morbidity in locally advanced mid-low rectal cancer resected by laparoscopy

Short Communication

Impact of incisional negative pressure wound therapy on perineal wound healing after abdominoperineal rectum extirpation

Original Article

Analysis of local recurrences after transanal endoscopic microsurgery for low risk rectal carcinoma

Original Article

Laparoscopic versus open distal pancreatectomy—a propensity score-matched analysis from the German StuDoQ|Pancreas registry

Original Article

Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer—a Swedish cohort study