![]() ![]() Left-sided CRC comprises two thirds of all colorectal malignancies. In China Medical University Hospital (CMUH), a tertiary medical center in Taichung City, a team of colorectal surgeons performs a high volume of cases for laparoscopic rectal surgeries. Laparoscopic approach for colon and rectal cancer was associated with less morbidity, enhanced recovery, and at least equivalent oncological outcomes. Laparoscopic surgery has gained increasing interest for the treatment of CRC. The evolution of laparoscopic-assisted compared to open approach colorectal surgery for diverticular disease and cancer was first introduced in the early 1990s and was aimed to offer the benefit of less trauma, without compromising functional and oncological outcomes. Based on the National Cancer Registry of Taiwan, CRC is the second most common invasive neoplastic disease with a total of 15,764 cases in 2014 and a crude incidence rate of 67.27%. The cancer burden will be increasing by 60% to more than 2.2 million new cases and resulting in 1.1 million deaths by 2030. It currently ranks third based on the GLOBOCAN (Global Cancer Incidence, Mortality and Prevalence) index and is also the fourth leading cause of cancer-related deaths. Shen-Ann Eugene Yeo, MBBS, MMed (Surg), FRCS (Ed) does not have any conflicts of interest or financial ties to disclose.One of the most commonly diagnosed malignancies in the world is colorectal cancer (CRC). This video attempts to provide a systematic approach to performing a laparoscopic splenic flexure mobilization as part of a colorectal resection.Ī detailed stepwise approach to splenic flexure mobilization will be shown here, as part of an anterior resection with splenic flexure takedown for a proximal sigmoid cancer.ĭr. As such, splenic flexure mobilization remains a challenge for many laparoscopic surgeons, particularly those who are at the early stages of their careers. Additionally, in obese patients, the large amount of mesenteric and omental fat can make it even more challenging to dissect. Also, critical organs which are prone to injury, namely the spleen and the pancreas, and the many blood vessels around them, lie very close to this area of dissection. Frequently, omental and congenital adhesions get in the way of a clear dissection plane. This is because of various factors, namely that the splenic flexure tends to be high up in the abdomen which may lead to difficulty of instrument reach. as part of a left hemicolectomy or anterior resection) tends to be one of the most challenging aspects. The authors of the video do not have any conflicts of interest or financial ties to disclose.Īmong the different laparoscopic colorectal surgical procedures which are commonly performed, splenic flexure mobilization (e.g. ![]() In a setting of surgeons experienced with laparoscopic colorectal surgery, the outcomes of laparoscopic segmental resection of splenic flexure are similar to those of laparoscopic resections for cancer in other locations. Additionally, an intracorporeal anastomosis minimizes the risk of bowel twisting, preventing the exteriorization of the stumps, and reducing bowel traction, which can affect anastomotic irrigation, especially in obese patients. The experience with a totally laparoscopic approach with intracorporeal anastomosis is well described in the current literature. As a result, a segmental resection associated with a medial-to-lateral approach could be safe and effective. Different studies showed that the majority of positive lymph nodes among patients with splenic flexure carcinoma are distributed along the paracolic arcade and the left colic artery. The oncological effectiveness of a segmental resection could be determined by the peculiar lymphatic spread of splenic flexure cancers. The resected area must include the mesocolon with major vessels ligation at their origin, in order to reduce local recurrence via the complete removal of potentially involved lymph node stations. The surgical approach is challenging and not fully standardized. It is associated with a high risk of obstruction and a poor prognosis. Splenic flexure carcinoma is a rare condition, as it represents 3 to 8% of all colon cancers. The objective of this video is to demonstrate a laparoscopic segmental oncological splenic flexure colonic resection for cancer. ![]()
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