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Laparoscopic Complete Mesocolic Excision for Double Flexural Colon Cancers

Takeru Matsuda MD, PhD, Hiroshi Hasegawa MD, PhD, Kimihiro Yamashita MD, PhD, Nobuhisa Takase MD, PhD, Gousuke Takiguchi MD, PhD, Masashi Yamamoto MD, PhD, Shingo Kanaji MD, PhD, Taro Oshikiri MD, PhD, Tetsu Nakamura MD, PhD, Satoshi Suzuki MD, PhD, Yoshihiro Kakeji MD, PhD
COLORECTAL CANCER
Volume 26, Issue 8 / August , 2019

Abstract

Background

Laparoscopic complete mesocolic excision (CME) for hepatic or splenic flexural colon cancer is considered technically demanding. The double (hepatic and splenic) flexural colon cancers are rare, and the laparoscopic CME procedure for such disease is not standardized.

Methods

This video presents laparoscopic CME for double (hepatic and splenic) flexural colon cancers using a medial and cranial approach.

Results

The patient was a 60-year-old woman with the diagnosis of splenic flexure cancer (cT4N1M0) and hepatic flexure cancer (cT3N0M0). Laparoscopic subtotal colectomy was performed. First, the left colic artery was divided at its origin, and the inferior mesenteric vein also was divided at the same level. The descending mesocolon was widely separated from the retroperitoneal tissues using a medial approach. Then, lymph node dissection along the surgical trunk was performed using a cranial approach. Finally, the transverse mesocolon was divided at the inferior border of the pancreas, and CME was achieved. The specimen was extracted through a small incision at the umbilicus, and side-to-side ileo-sigmoid anastomosis was performed extracorporeally.

Conclusions

The approach presented in the video might be useful for standardization of laparoscopic CME for double flexural colon cancers.

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