Management of postoperative complications after laparoscopic left hemicolectomy - an approach in modern times after incorporation of indocyanine green (ICG) and full mobilization of the splenic flexure

Introduction: Splenic flexure tumors are quite rare, accounting for 2% to 8% of all colorectal cancers. The heterogeneity of the vascular support and lymphatic drainage of the splenic flexure make the surgical management complex and non-standardized. The aim of the study is to compare the four surgical techniques (extended right hemicolectomy, left hemicolectomy, segmental colonic resection, and total colectomy) in terms of short-term and long-term outcomes.Materials and Methods: Consecutive patients from two hospitals of Turin (the Martini hospital and the San Giovanni Bosco hospital) between September 1998 and March 2020 have surgical visit for splenic flexure cancer. The data reported in the database include preoperative, postoperative, histopathological characteristics, and survival results. Univariate and multivariate analysis are performed to evaluate the confounding factors influencing overall and disease-free survival.Results and Discussion: A total of 173 patients treated for splenic flexure tumors are included in the study. The four groups are similar on the baseline characteristics of the patients. Clavien Dindo ≥ 3 postoperative complications and 30-day mortality are comparable in the four groups (p=0.216 e p=0.213). Five-year overall survival and progression-free survival did not show significant differences between the four surgical techniques (p=1.08 e p=0.28). No statistically significant differences were found between the four groups for baseline patient characteristics, intraoperative outcomes, postoperative complications, and TNM staging.Conclusion: Segmental colonic resection, extended right hemicolectomy, left hemicolectomy and total colectomy show no significant difference in short-term and oncological outcomes in cancer of the splenic flexure. Further studies with a higher level of evidence are needed.

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Laparoscopic left hemicolectomy with regional lymph node navigation and intracorporeal anastomosis for splenic flexure colon cancer

International Cancer Conference Journal ◽

10.1007/s13691-020-00424-4 ◽

2020 ◽

Vol 9 (4) ◽

pp. 170-174

Author(s):

Yoshiro Itatani ◽

Kenji Kawada ◽

Koya Hida ◽

Yasunori Deguchi ◽

Nobu Oshima ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Splenic Flexure ◽

Regional Lymph Node ◽

Intracorporeal Anastomosis ◽

Left Hemicolectomy

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Peculiarities of the postoperative period and postoperative consequences of left hemicolectomy in patients with obesity

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(1)-08 ◽

2021 ◽

Vol 25 (1) ◽

pp. 45-49

Author(s):

A. I. Sukhodolia ◽

V. V. Kernychnyi ◽

V. V. Balytskyi ◽

S. A. Sukhodolia ◽

B. E. Li

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Postoperative Mortality ◽

Charlson Index ◽

Obese Patients ◽

Microsoft Excel ◽

Mean Values ◽

Left Hemicolectomy ◽

Multi Stage ◽

The Impact

Annotation. Obesity is considered a risk factor for postoperative complications and postoperative mortality. The aim of the study was to assess the impact of obesity on the postoperative period and the level of postoperative mortality after left hemicolectomy. A retrospective analysis of the medical records of 217 patients who underwent left hemicolectomy for colon tumors was performed. Assessment of comorbid conditions was performed using the Charlson index. Postoperative complications were assessed according to the Clavien-Dindo classification. The calculation of postoperative survival was performed by the Kaplan-Mayer method. Database formation and statistical analysis were performed using Microsoft Excel and STATISTICA 10.0. It was determined that the mean values of the Charlson index did not differ significantly between the two groups (6,31 ± 2,07 and 6,33 ± 2,08 respectively), but there was a significantly higher level of endocrine diseases in the group of obese patients. Non-disseminated (I-II) stages of the tumor process predominated in patients of both groups (60% and 57.5%, respectively). Among non-obese patients n = 107 (51.8%) patients had an uncomplicated postoperative period and n = 59 (28.5%) patients had mild complications that were not associated with the surgical site, but were associated with concomitant chronic pathology of other organs and systems, and did not require any invasive interventions. In contrast, among obese patients n = 6 (60%) patients had severe early postoperative complications requiring surgery, and n = 2 (20%) patients underwent relaparotomy. The rate of early postoperative mortality differed significantly between the two groups and was significantly higher among obese patients (40% vs 6.8% among non-obese patients). This study showed a significantly higher percentage of postoperative mortality and severity of postoperative complications in the group of obese patients. The prospect of further research is to study and analyze the course of the postoperative period in obese patients undergoing extended, multi-visceral and multi-stage surgery for cancer of the left half of the colon.

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Use of near-infrared imaging using indocyanine green associates with the lower incidence of postoperative complications for intestinal and mesenteric injury

Scientific Reports ◽

10.1038/s41598-021-03361-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Keishi Yamaguchi ◽

Takeru Abe ◽

Kento Nakajima ◽

Chikara Watanabe ◽

Yusuke Kawamura ◽

...

Keyword(s):

Postoperative Complications ◽

Indocyanine Green ◽

Anastomotic Leakage ◽

Lower Incidence ◽

Lower Risk ◽

Near Infrared ◽

Infrared Imaging ◽

Intestinal Resection ◽

Near Infrared Imaging ◽

Vascular Perfusion

AbstractAnastomotic leakage after intestinal resection is one of the most serious complications of surgical intervention for hollow viscus injury. Adequate vascular perfusion of the anastomotic site is essential to prevent anastomotic leakage. Near-infrared imaging using indocyanine green (NIR-ICG) is useful for the objective assessment of vascular perfusion. The aim of this study was to evaluate the association of NIR-ICG with intestinal and mesenteric injuries. This was a retrospective, single-center study of patients undergoing surgery for intestinal and mesenteric injuries. NIR-ICG was used to evaluate vascular perfusion. Postoperative complications were assessed between NIR-ICG and non-NIR-ICG groups.The use of NIR-ICG was associated with a lower incidence of Clavien-Dindo grade ≥ III complications with a statistical tendency (p = 0.076). When limited to patients that underwent intestinal resection, the use of NIR-ICG was significantly associated with a lower risk of perioperative complications (p = 0.009). The use of NIR-ICG tended to associate with the lower incidence of postoperative complications after intestinal and mesenteric trauma surgery. NIR-ICG was associated with a significantly lower risk of complications in patients undergoing intestinal resection. The NIR-ICG procedure is simple and quick and is expected to be useful for intestinal and mesenteric trauma.

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Use of Near-Infrared Imaging using Indocyanine Green Associates with the Lower Incidence of Postoperative Complications After Surgery for Intestinal and Mesenteric Injury

10.21203/rs.3.rs-829393/v1 ◽

2021 ◽

Author(s):

Keishi Yamaguchi ◽

Takeru Abe ◽

Kento Nakajima ◽

Chikara Watanabe ◽

Yusuke Kawamura ◽

...

Keyword(s):

Postoperative Complications ◽

Indocyanine Green ◽

Anastomotic Leakage ◽

Lower Incidence ◽

Lower Risk ◽

Near Infrared ◽

Infrared Imaging ◽

Intestinal Resection ◽

Near Infrared Imaging ◽

Vascular Perfusion

Abstract BackgroundAnastomotic leakage after intestinal resection is one of the most serious complications of surgical intervention for hollow viscus injury. Adequate vascular perfusion of the anastomotic site is essential to prevent anastomotic leakage. Near-infrared imaging using indocyanine green (NIR-ICG) is useful for the objective assessment of vascular perfusion. The aim of this study was to evaluate the association of NIR-ICG with intestinal and mesenteric injuries.MethodsThis was a retrospective, single-center study of patients undergoing surgery for intestinal and mesenteric injuries due to abdominal trauma from December 2006 to March 2021. NIR-ICG was used to evaluate vascular perfusion. Postoperative complications were assessed between NIR-ICG and non-NIR-ICG groups. ResultsThe use of NIR-ICG was associated with a lower incidence of Clavien-Dindo grade ≥ III complications with a statistical tendency (p = 0.076). No Clavien-Dindo grade ≥ II intestinal complications were observed in the NIR-ICG group. When limited to patients that underwent intestinal resection, the use of NIR-ICG was significantly associated with a lower risk of perioperative complications (p = 0.009).ConclusionsThe use of NIR-ICG tended to associate with the lower incidence of postoperative complications after intestinal and mesenteric trauma surgery. NIR-ICG was associated with a significantly lower risk of complications in patients undergoing intestinal resection. The NIR-ICG procedure is simple and quick and is expected to be useful for intestinal and mesenteric trauma.

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Subtotal colectomy, extended right hemicolectomy, left hemicolectomy, or splenic flexure colectomy for splenic flexure tumors: a network meta-analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-020-03763-z ◽

2020 ◽

Author(s):

Xiaojie Wang ◽

Zhifang Zheng ◽

Min Chen ◽

Xingrong Lu ◽

Shenghui Huang ◽

...

Keyword(s):

Splenic Flexure ◽

Subtotal Colectomy ◽

Meta Analysis ◽

Right Hemicolectomy ◽

Left Hemicolectomy

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Splenic flexure and left hemicolectomy

Laparoscopic Colorectal Surgery ◽

10.4324/9781315175751-8 ◽

2017 ◽

pp. 87-99

Author(s):

Kathryn Thomas ◽

Charles Maxwell-Armstrong ◽

Austin Acheson

Keyword(s):

Splenic Flexure ◽

Left Hemicolectomy

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Comment on ‘Comparison of extended right hemicolectomy, left hemicolectomy, and segmental colectomy for splenic flexure colon cancer (SFC): a systematic review and meta‐analysis’

Colorectal Disease ◽

10.1111/codi.15358 ◽

2020 ◽

Vol 22 (12) ◽

pp. 2332-2333 ◽

Cited By ~ 1

Author(s):

X. Wang ◽

Z. Zheng ◽

Q. Yu ◽

P. Chi

Keyword(s):

Systematic Review ◽

Colon Cancer ◽

Splenic Flexure ◽

Meta Analysis ◽

Right Hemicolectomy ◽

Left Hemicolectomy ◽

Segmental Colectomy

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Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02240-7 ◽

2021 ◽

Author(s):

Salomone Di Saverio ◽

Kostantinos Stasinos ◽

Weronyka Stupalkowska ◽

Umberto Bracale ◽

Pierpaolo Sileri ◽

...

Keyword(s):

Splenic Flexure ◽

Primary Anastomosis ◽

Colorectal Anastomosis ◽

Ascending Colon ◽

Right Colon ◽

Left Hemicolectomy ◽

Tension Free ◽

Descending Colon ◽

Deloyers Procedure ◽

The Right

Abstract Introduction This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. Background While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. Technique and methods Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. Results This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. Conclusions Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.

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