Three surgical planes identified in laparoscopic complete mesocolic excision for right-sided colon cancer.

Da-Jian Zhu,Yan Lu,Xiao-Wu Chen,Man-Zhao Ouyang

doi:10.1186/s12957-015-0758-4

Abstract

BackgroundComplete mesocolic excision provides a correct anatomical plane for colon cancer surgery. However, manifestation of the surgical plane during laparoscopic complete mesocolic excision versus in computed tomography images remains to be examined.MethodsPatients who underwent laparoscopic complete mesocolic excision for right-sided colon cancer underwent an abdominal computed tomography scan. The spatial relationship of the intraoperative surgical planes were examined, and then computed tomography reconstruction methods were applied. The resulting images were analyzed.ResultsIn 44 right-sided colon cancer patients, the surgical plane for laparoscopic complete mesocolic excision was found to be composed of three surgical planes that were identified by computed tomography imaging with cross-sectional multiplanar reconstruction, maximum intensity projection, and volume reconstruction. For the operations performed, the mean bleeding volume was 73 ± 32.3 ml and the mean number of harvested lymph nodes was 22 ± 9.7. The follow-up period ranged from 6–40 months (mean 21.2), and only two patients had distant metastases.ConclusionsThe laparoscopic complete mesocolic excision surgical plane for right-sided colon cancer is composed of three surgical planes. When these surgical planes were identified, laparoscopic complete mesocolic excision was a safe and effective procedure for the resection of colon cancer.

Highlights

Complete mesocolic excision provides a correct anatomical plane for colon cancer surgery
The aim of this study was to identify the composition and spatial relationship of the surgical planes for laparoscopic complete mesocolic excision (LCME) for right-sided colon cancer, as well as the surgical planes observed by computed tomography (CT) imaging for LCME, based on observed anatomy, CT imaging of anatomical features, and embryonic development of the gastrointestinal tract
Incision infection due to fat liquefaction (n = 2), intestinal adhesions and intestinal obstruction that occurred after symptomatic treatment (n = 1), an incisional hernia (n = 2), multiple liver and lung metastases detected by CT 6 months later (n = 1), and CT suggestive of multiple liver metastases detected 9 months later (n = 1) were reported (Table 1)

Summary

Introduction

Complete mesocolic excision provides a correct anatomical plane for colon cancer surgery. Manifestation of the surgical plane during laparoscopic complete mesocolic excision versus in computed tomography images remains to be examined. The concept and procedure for complete mesocolic excision (CME) was initially proposed by Hohenberger et al [1, 2] in 2009, and it provided a correct anatomical plane and surgical approach for most cases of colon cancer. The fascia space [5, 6] has no major blood vessels or nerves and can be conveniently and safely separated and modified. CME follows this fascial space as a natural surgical plane by which to perform an excision. Manifestation of the LCME surgical plane during colon cancer surgery versus visualization of the LCME surgical plane with computed tomography (CT) imaging remains to be examined

Objectives

Methods

Results

Discussion

Conclusion