Evaluation of our medial approach and mesenteric resection range by ICG in transverse colon cancer
EAES Academy. Tatsuya K. 07/05/22; 363000; P043
Dr. Kinjo Tatsuya
Contributions
Contributions
Abstract
Introduction:
Since the vessels of the transverse colon are often anatomically exceptional and is embryologically the boundary between the midgut and the hindgut, the approach method and the appropriate lymph node dissection range have not yet been standardized. We perform dissection based on the medial approach using the evaluation of lymphatic flow around the tumor by ICG.
(Aim) We investigated lymph node metastasis in transverse colon cancer and procedures of our medial approach and dissection range determination method.
(Patients) Twenty-five cases of primary transverse colon cancer who underwent transverse colon resection between 2010 and December 2020.
(Procedures) ICG was injected around the tumor. The Ileocecal region to hepatic curvature was detached for hepatic-sided cancer, or IMV medial to spleen curvature was detached for splenic-sided cancer. Next, we determined whether hemicolectomy or partial resection according to lymphatic flow. The following procedures were performed along the surface of the transverse retrocolic space (TRCS). The MCA or either branch was resected for D3 resection. After entering the side of the omental bursa in transverse colon mesentery, complete mesenteric excision (CME) was performed from the layer of the pancreatic head-duodenum plus the adipose tissue including subpyloric lymph nodes along to the surface of the TRCS. Lastly, the remaining another side of mesentery and colon dissection was performed, and CME was completed only with the medial approach.
(Results) Age 72 years (54-86), male / female: 16/9, open / laparoscopy = 9/16. pStage I / IIa / IIb / IIIb / IIIc = 6/12/3/3/1. Right hemicolectomy in 5 cases, transverse colon resection in 17 cases, and left hemicolectomy in 3 cases. There were 2 recurrences, 1 was a recurrence of # 223 metastasis in a D2 dissection case.
(Conclusion) It was considered that mesenteric dissection without excess or deficiency was possible by medial approach and observing lymphatic flow by ICG.
Since the vessels of the transverse colon are often anatomically exceptional and is embryologically the boundary between the midgut and the hindgut, the approach method and the appropriate lymph node dissection range have not yet been standardized. We perform dissection based on the medial approach using the evaluation of lymphatic flow around the tumor by ICG.
(Aim) We investigated lymph node metastasis in transverse colon cancer and procedures of our medial approach and dissection range determination method.
(Patients) Twenty-five cases of primary transverse colon cancer who underwent transverse colon resection between 2010 and December 2020.
(Procedures) ICG was injected around the tumor. The Ileocecal region to hepatic curvature was detached for hepatic-sided cancer, or IMV medial to spleen curvature was detached for splenic-sided cancer. Next, we determined whether hemicolectomy or partial resection according to lymphatic flow. The following procedures were performed along the surface of the transverse retrocolic space (TRCS). The MCA or either branch was resected for D3 resection. After entering the side of the omental bursa in transverse colon mesentery, complete mesenteric excision (CME) was performed from the layer of the pancreatic head-duodenum plus the adipose tissue including subpyloric lymph nodes along to the surface of the TRCS. Lastly, the remaining another side of mesentery and colon dissection was performed, and CME was completed only with the medial approach.
(Results) Age 72 years (54-86), male / female: 16/9, open / laparoscopy = 9/16. pStage I / IIa / IIb / IIIb / IIIc = 6/12/3/3/1. Right hemicolectomy in 5 cases, transverse colon resection in 17 cases, and left hemicolectomy in 3 cases. There were 2 recurrences, 1 was a recurrence of # 223 metastasis in a D2 dissection case.
(Conclusion) It was considered that mesenteric dissection without excess or deficiency was possible by medial approach and observing lymphatic flow by ICG.
Introduction:
Since the vessels of the transverse colon are often anatomically exceptional and is embryologically the boundary between the midgut and the hindgut, the approach method and the appropriate lymph node dissection range have not yet been standardized. We perform dissection based on the medial approach using the evaluation of lymphatic flow around the tumor by ICG.
(Aim) We investigated lymph node metastasis in transverse colon cancer and procedures of our medial approach and dissection range determination method.
(Patients) Twenty-five cases of primary transverse colon cancer who underwent transverse colon resection between 2010 and December 2020.
(Procedures) ICG was injected around the tumor. The Ileocecal region to hepatic curvature was detached for hepatic-sided cancer, or IMV medial to spleen curvature was detached for splenic-sided cancer. Next, we determined whether hemicolectomy or partial resection according to lymphatic flow. The following procedures were performed along the surface of the transverse retrocolic space (TRCS). The MCA or either branch was resected for D3 resection. After entering the side of the omental bursa in transverse colon mesentery, complete mesenteric excision (CME) was performed from the layer of the pancreatic head-duodenum plus the adipose tissue including subpyloric lymph nodes along to the surface of the TRCS. Lastly, the remaining another side of mesentery and colon dissection was performed, and CME was completed only with the medial approach.
(Results) Age 72 years (54-86), male / female: 16/9, open / laparoscopy = 9/16. pStage I / IIa / IIb / IIIb / IIIc = 6/12/3/3/1. Right hemicolectomy in 5 cases, transverse colon resection in 17 cases, and left hemicolectomy in 3 cases. There were 2 recurrences, 1 was a recurrence of # 223 metastasis in a D2 dissection case.
(Conclusion) It was considered that mesenteric dissection without excess or deficiency was possible by medial approach and observing lymphatic flow by ICG.
Since the vessels of the transverse colon are often anatomically exceptional and is embryologically the boundary between the midgut and the hindgut, the approach method and the appropriate lymph node dissection range have not yet been standardized. We perform dissection based on the medial approach using the evaluation of lymphatic flow around the tumor by ICG.
(Aim) We investigated lymph node metastasis in transverse colon cancer and procedures of our medial approach and dissection range determination method.
(Patients) Twenty-five cases of primary transverse colon cancer who underwent transverse colon resection between 2010 and December 2020.
(Procedures) ICG was injected around the tumor. The Ileocecal region to hepatic curvature was detached for hepatic-sided cancer, or IMV medial to spleen curvature was detached for splenic-sided cancer. Next, we determined whether hemicolectomy or partial resection according to lymphatic flow. The following procedures were performed along the surface of the transverse retrocolic space (TRCS). The MCA or either branch was resected for D3 resection. After entering the side of the omental bursa in transverse colon mesentery, complete mesenteric excision (CME) was performed from the layer of the pancreatic head-duodenum plus the adipose tissue including subpyloric lymph nodes along to the surface of the TRCS. Lastly, the remaining another side of mesentery and colon dissection was performed, and CME was completed only with the medial approach.
(Results) Age 72 years (54-86), male / female: 16/9, open / laparoscopy = 9/16. pStage I / IIa / IIb / IIIb / IIIc = 6/12/3/3/1. Right hemicolectomy in 5 cases, transverse colon resection in 17 cases, and left hemicolectomy in 3 cases. There were 2 recurrences, 1 was a recurrence of # 223 metastasis in a D2 dissection case.
(Conclusion) It was considered that mesenteric dissection without excess or deficiency was possible by medial approach and observing lymphatic flow by ICG.
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