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01-08-2017 | Review Article

Laparoscopic Colorectal Surgery for Cancer: What Is the Role of Complete Mesocolic Excision and Splenic Flexure Mobilization?

Authors: Rosario Vecchio, Salvatore Marchese, Eva Intagliata

Published in: Indian Journal of Surgery | Issue 4/2017

Abstract

Laparoscopic colorectal surgery for cancer is nowadays routinely performed worldwide. After the introduction by Heald of total mesorectal excision for rectal cancer, also a complete mesocolic excision has been advocated as an essential surgical step to improve oncologic results in patients with colon cancer. The complete removal of mesocolon with high ligation of the main mesenteric arteries and veins and the mobilization of splenic flexure are well-known but still debated in western surgical society. The authors reviewed the literature and outlined the rationale and the results of splenic flexure mobilization and complete mesocolic excision in laparoscopic surgery for colorectal cancer.

Schoetz DJ Jr (2006) Evolving practice patterns in colon and rectal surgery. J Am Coll Surg 203(3):322–327CrossRefPubMed

Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81(9):503–508PubMedPubMedCentral

Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study Group (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740CrossRefPubMed

Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC, EORTC Radiotherapy Group Trial 22921 (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355(11):1114–1123CrossRefPubMed

Chow CF, Kim SH (2014) Laparoscopic complete mesocolic excision: West meets East. World J Gastroenterol 20(39):14301–14307. doi:10.3748/wjg.v20.i39.14301 CrossRefPubMedPubMedCentral

Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Color Dis 2009;11(4):354–364; discussion 364-5. doi: 10.1111/j.1463-1318.2008.01735.x.CrossRef

Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D, National Cancer Institute Expert Panel (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93(8):583–596CrossRefPubMed

Akiyoshi T, Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Konishi T, Yamaguchi T (2010) Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer. Surg Endosc 24(11):2749–2754. doi:10.1007/s00464-010-1039-5 CrossRefPubMed

Farke S, Bouchard R, Blumberg C, Keller R, Roblick UJ, Bruch HP, Fischer F (2010) Mobilization of the splenic flexure: a standard in laparoscopic left colon and rectum resections! Surg J 5:31–35. doi:10.3923/sjour.2010.31.35 CrossRef

10.

Brennan DJ, Moynagh M, Brannigan AE, Gleeson F, Rowland M, O’Connell PR (2007) Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon rectum 50(3):302–307 discussion 307

11.

Katory M, Tang CL, Koh WL, Fook-Chong SM, Loi TT, Ooi BS, Ho KS, Eu KW (2008) A 6-year review of surgical morbidity and oncological outcome after high anterior resection for colorectal malignancy with and without splenic flexure mobilization. Color Dis 10(2):165–169

12.

Gezen C, Altuntas YE, Kement M, Vural S, Civil O, Okkabaz N, Aksakal N, Oncel M (2012) Complete versus partial mobilization of splenic flexure during laparoscopic low anterior resection for rectal tumors: a comparative study. J Laparoendosc Adv Surg Tech A. 22(4):392–396. doi:10.1089/lap.2011.0409 CrossRefPubMed

13.

Kim HJ, Kim CH, Lim SW, Huh JW, Kim YJ, Kim HR (2013) An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection. Color Dis 15(2):e93–e98. doi:10.1111/codi.12056 CrossRef

14.

Langevin JM, Rothenberger DA, Goldberg SM (1984) Accidental splenic injury during surgical treatment of the colon and rectum. Surg Gynecol Obstet 159(2):139–144PubMed

15.

Holubar SD, Wang JK, Wolff BG, Nagorney DM, Dozois EJ, Cima RR, O’Byrne MM, Qin R, Larson DW (2009) Splenic salvage after intraoperative splenic injury during colectomy. Arch Surg 144(11):1040–1045. doi:10.1001/archsurg.2009.188 CrossRefPubMed

16.

Vecchio R, Marchese S, Swehli E, Intagliata E (2011) Splenic hilum management during laparoscopic splenectomy. J Laparoendosc Adv Surg Tech A 21(8):717–720. doi:10.1089/lap.2011.0165 CrossRefPubMed

17.

Vecchio R, Intagliata E, Marchese S, La Corte F, Cacciola RR, Cacciola E (2014) Laparoscopic splenectomy coupled with laparoscopic cholecystectomy. JSLS 18(2):252–257. doi:10.4293/108680813X13693422518434 CrossRefPubMedPubMedCentral

18.

Vecchio R, Cacciola E, Martino M, Cacciola RR, MacFadyen BV (2003) Modifications of coagulation and fibrinolytic parameters in laparoscopic cholecystectomy. Surg Endosc 17(3):428–433CrossRefPubMed

19.

Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 6(7):477–484CrossRefPubMed

20.

Benseler V, Hornung M, Iesalnieks I, von Breitenbuch P, Glockzin G, Schlitt HJ, Agha A (2012) Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection. Int J Color Dis 27(11):1521–1529. doi:10.1007/s00384-012-1495-6 CrossRef

21.

Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg 2008;143(8):762–767; discussion 768. doi: 10.1001/archsurg.143.8.762.CrossRefPubMed

22.

Marsden MR, Conti JA, Zeidan S, Flashman KG, Khan JS, O’Leary DP, Parvaiz A (2012) The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections. Color Dis 14(10):1255–1261. doi:10.1111/j.1463-1318.2011.02927.x CrossRef

23.

Araujo SE, Seid VE, Kim NJ, Bertoncini AB, Nahas SC, Cecconello I (2012) Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study. Arq Gastroenterol 49(3):219–222CrossRefPubMed

24.

Thum-umnuaysuk S, Boonyapibal A, Geng YY, Pattana-Arun J (2013) Lengthening of the colon for low rectal anastomosis in a cadaveric study: how much can we gain? Tech Coloproctol. 17(4):377–381. doi:10.1007/s10151-012-0930-6 CrossRefPubMed

25.

Kye BH, Kim HJ, Kim HS, Kim JG, Cho HM (2014) How much colonic redundancy could be obtained by splenic flexure mobilization in laparoscopic anterior or low anterior resection? Int J Med Sci 11(9):857–862. doi:10.7150/ijms.8874 eCollection 2014 CrossRefPubMedPubMedCentral

26.

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):1763–1769. doi:10.1200/JCO.2011.38.3992 CrossRefPubMed

27.

Vecchio R, MacFayden BV, Palazzo F (2000) History of laparoscopic surgery. Panminerva Med 42(1):87–90PubMed

28.

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):272–278. doi:10.1200/JCO.2009.24.1448 CrossRefPubMed

29.

Hohenberger W, Merkel S, Weber K (2007) Lymphadenektomie bei Tumoren des unteren Gastrointestinaltraktes. Chirug 78:217–225. doi:10.1007/s00104-007-1311-y CrossRef

30.

West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P (2008) Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 9(9):857–865. doi:10.1016/S1470-2045(08)70181-5 CrossRefPubMed

31.

Culligan K, Coffey JC, Kiran RP, Kalady M, Lavery IC, Remzi FH The mesocolon: a prospective observational study. Color Dis 2012;14(4):421–428; discussion 428-30. doi: 10.1111/j.1463-1318.2012.02935.x.CrossRef

32.

Culligan K, Walsh S, Dunne C, Walsh M, Ryan S, Quondamatteo F, Dockery P, Coffey JC (2014) The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg 260(6):1048–1056. doi:10.1097/SLA.0000000000000323 CrossRefPubMed

33.

Liang JT, Huang KC, Lai HS, Lee PH, Sun CT (2007) Oncologic results of laparoscopic D3 lymphadenectomy for male sigmoid and upper rectal cancer with clinically positive lymph nodes. Ann Surg Oncol 14(7):1980–1990CrossRefPubMed

34.

Merrie AE, Phillips LV, Yun K, McCall JL (2001) Skip metastases in colon cancer: assessment by lymph node mapping using molecular detection. Surgery 129(6):684–691CrossRefPubMed

35.

Tan KY, Kawamura YJ, Mizokami K, Sasaki J, Tsujinaka S, Maeda T, Nobuki M, Konishi F (2010) Distribution of the first metastatic lymph node in colon cancer and its clinical significance. Color Dis 12(1):44–47. doi:10.1111/j.1463-1318.2009.01924.x CrossRef

36.

Park JS, Choi GS, Lim KH, Jang YS, Kim HJ, Park SY, Jun SH (2010) Clinical outcome of laparoscopic right hemicolectomy with transvaginal resection, anastomosis, and retrieval of specimen. Dis Colon rectum 53(11):1473–1479. doi:10.1007/DCR.0b013e3181f1cc17

37.

Uematsu D, Akiyama G, Magishi A (2011) Multimedia article. Radical lymphadenectomy for advanced colon cancer via separation of the mesocolon into two layers as in filleting fish. Surg Endosc 25(5):1659–1660. doi:10.1007/s00464-010-1439-6 CrossRefPubMed

38.

Feng B, Sun J, Ling TL, Lu AG, Wang ML, Chen XY, Ma JJ, Li JW, Zang L, Han DP, Zheng MH (2012) Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies. Surg Endosc 26(12):3669–3675. doi:10.1007/s00464-012-2435-9 CrossRefPubMed

39.

Wang JP (2011) Chinese standard for the diagnosis and treatment of colorectal cancer (2010). Zhonghua Wei Chang Wai Ke Za Zhi 14(1):1–4PubMed

40.

Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17(1):1–29. doi:10.1007/s10147-011-0315-2 CrossRefPubMed

41.

(1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg 13(6):557–73

42.

Faerden AE, Sjo OH, Bukholm IR, Andersen SN, Svindland A, Nesbakken A, Bakka A (2011) Lymph node micrometastases and isolated tumor cells influence survival in stage I and II colon cancer. Dis Colon rectum 54(2):200–206. doi:10.1007/DCR.0b013e3181fd4c7c

43.

(2009) Sobin LGM, Wittekind C (eds). International Union Against Cancer TNM Classification of Malignant Tumours, 7th edn. Wiley, Hoboken

44.

Bokey EL, Chapuis PH, Dent OF, Mander BJ, Bissett IP, Newland RC (2003) Surgical technique and survival in patients having a curative resection for colon cancer. Dis Colon rectum 46(7):860–866

45.

Storli KE, Søndenaa K, Furnes B, Nesvik I, Gudlaugsson E, Bukholm I, Eide GE (2014) Short term results of complete (D3) vs. standard (D2) mesenteric excision in colon cancer shows improved outcome of complete mesenteric excision in patients with TNM stages I-II. Tech Coloproctol 18(6):557–564. doi:10.1007/s10151-013-1100-1 CrossRefPubMed

46.

Galizia G, Lieto E, De Vita F, Ferraraccio F, Zamboli A, Mabilia A, Auricchio A, Castellano P, Napolitano V, Orditura M (2014) Is complete mesocolic excision with central vascular ligation safe and effective in the surgical treatment of right-sided colon cancers? A prospective study. Int J Color Dis 29(1):89–97. doi:10.1007/s00384-013-1766-x CrossRef

47.

Ding J, Liao GQ, Xia Y, Zhang ZM, Pan Y, Liu S, Zhang Y, Yan ZS (2013) Medial versus lateral approach in laparoscopic colorectal resection: a systematic review and meta-analysis. World J Surg 37(4):863–872. doi:10.1007/s00268-012-1888-2 Review CrossRefPubMed

48.

Gouvas N, Pechlivanides G, Zervakis N, Kafousi M, Xynos E (2012) Complete mesocolic excision in colon cancer surgery: a comparison between open and laparoscopic approach. Color Dis 14(11):1357–1364. doi:10.1111/j.1463-1318.2012.03019.x CrossRef

49.

Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, Rieger NA, Smith JS, Solomon MJ, Stevenson AR, Australasian Laparoscopic Colon Cancer Study Group (2012) Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg 256(6):915–919. doi:10.1097/SLA.0b013e3182765ff8 CrossRefPubMed

50.

Storli KE, Søndenaa K, Furnes B, Eide GE (2013) Outcome after introduction of complete mesocolic excision for colon cancer is similar for open and laparoscopic surgical treatments. Dig Surg 30(4–6):317–327. doi:10.1159/000354580 Erratum in: Dig Surg. 2013;30(4-6):327 CrossRefPubMed

Title: Laparoscopic Colorectal Surgery for Cancer: What Is the Role of Complete Mesocolic Excision and Splenic Flexure Mobilization?
Authors: Rosario Vecchio
Salvatore Marchese
Eva Intagliata
Publication date: 01-08-2017
Publisher: Springer India
Published in: Indian Journal of Surgery / Issue 4/2017
Print ISSN: 0972-2068
Electronic ISSN: 0973-9793
DOI: https://doi.org/10.1007/s12262-017-1631-1

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Laparoscopic Colorectal Surgery for Cancer: What Is the Role of Complete Mesocolic Excision and Splenic Flexure Mobilization?

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