3/3/2023 0 Comments Intestinal flexture![]() The clinical parameters we recorded included preoperative patient characteristics as demographics, body mass index (BMI), American Society of Anesthesiologists (ASA) score, previous surgical history. ![]() The CT scan was completed by virtual colonoscopy in 7 patients in order to improve cancer localization, to study the proximal colon in cases of non complete endoscopic exam and to evaluate the descending colon lenght.ĭata regarding each patient entering the study were retrospectively collected and stored in a computerized database designed specifically to record the safety of laparoscopic colon surgery and follow the short- and medium-term outcomes. During traditional colonoscopy endoscopic tattooing with indian ink was performed in all patients. ![]() Precise preoperative localization of the tumor was considered mandatory for laparoscopic resection planning. Cancer staging was realized with thoracic and abdominal CT scan. Diagnosis was made by colonoscopy and biopsy in all patients. In patients with advanced stage at diagnosis or bulky disease, an open resection was the operation of choice in case of adjacent organ involvement an en-bloc resection was performed. Exclusion criteria were totally obstructing tumors and locally advanced cancers (T4b). From October 2005 to May 2014 minimally invasive approach was proposed to all patients with histological diagnosis of splenic flexure carcinoma, including patients with previous abdominal surgery or obesity. Splenic flexure cancer was defined as a tumor located in the distal third of the transverse colon, or in the left colonic angle, or in the proximal descending colon within 10 cm from the flexure. Aim of this study is to review our experience in laparoscopic treatment of splenic flexure tumors and to compare our data to the more recent literature. The main controversies include the appropriate extent of colon resection and lymph node dissection, the risk of inadvertent splenectomy and the type of anastomosis. For this reason the treatment of cancer of the splenic flexure is not standardized, and the minimally invasive approach, especially if totally laparoscopic, is still considered very challenging. Ultimately, splenic flexure location has never been included in randomized controlled trials designed to assess the efficacy of laparoscopic surgery as a curative treatment for colon cancer. However, all these studies excluded patients with transverse colon and splenic flexure lesions, probably because of technical difficulties specific to this location, as identification of middle and left colic vessels and anastomosis construction. They also clearly showed the short-term advantages of the laparoscopic approach, including less postoperative pain, improved respiratory function, early canalization and shorter hospital stay. The most important prospective trials have revealed no differences between laparoscopic and open surgery in terms of lymph node harvest and resection margins clearance. Laparoscopic surgery of colon cancer has been the subject of great interest since the first reports in 1991. ConclusionsĪlthough our experience is limited and appropriate indications must be set by future randomized studies, we believe that laparoscopic resection with intracorporeal anastomosis appears feasible and safe for patients affected by splenic flexure cancer. As regard major postoperative complications, one case of postoperative acute pancreatitis and one case of postoperative bleeding from the anastomotic suture line were reported. Mean operative time was 190 min and mean estimated blood loss was equal to 55 ml. The mean number of harvested lymph nodes was 20.8. Specimen mean length was 21.2 cm, while the distance of distal and proximal resection margin from tumor site was 6.5 and 11.5 respectively. In 7 cases the anastomosis was performed intracorporeally. ![]() Methodsįrom October 2005 to May 2014 laparoscopic splenic flexure resection was performed in 23 patients. Intraoperative, pathologic and postoperative data from patients undergoing laparoscopic splenic flexure resection were analyzed to assess oncological safety as well as early and medium-term outcomes. This study reviews two Institutions experience in laparoscopic treatment of left colonic flexure cancer. Laparoscopic approach is still considered a challenging procedure. The treatment of colon cancer located in splenic flexure is not standardized.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |