Description
Colorectal cancers continue to be an important global cause of morbidity and mortality, despite all the advances in treatment approaches. Currently, radical surgery is the only known curative treatment option. The positive effects of the Complete Mesocolic Excision (CME) with right hemicolectomy technique on survival and local recurrence rates are indisputable.1,2 Hohenberger et al.1 showed the effect of CME on 5-year survival increased from 82.1% to 89.1%. Thus, high ligation of blood vessels at the D3 level and CME are two critical features of the treatment of ascendant colon cancer.1 This laparoscopic approach, which normally requires extreme care, becomes even more challenging in locally advanced tumors.3
Surgical resection of tumors without local advancement is known to result in a lower morbidity and mortality than locally advanced colon tumors. However, the benefit of extensive surgery cannot be underestimated in the case of locally advanced tumors. Extensive surgery with careful lymph node dissection (LND) based on a no-touch isolation technique remains the gold standard.4 Here, we present a 68-year-old man with a locally advanced hepatic flexure tumor. Physical examination was uninformative. Colonoscopy revealed near total obstruction at the hepatic flexure. Computed tomography showed an irregular wall at the hepatic flexure. Radiology did not suggest invasion of adjacent organs. Postoperative pathological result was pT4b pN0 (0/21) M0 (phaseII C, AJCC). This video presentation illustrates total laparoscopic right hemicolectomy with D3 LND and CME, cholecystectomy and gastric and duodenum wedge resection. Reconstruction was performed with a Roux-en-Y gastro-enterostomy and ileotransversostomy from the region of the resection, with tissue preservation. In this video we wanted to show how the difficulties encountered during the operation are managed, as it is not possible to predict local advanced tumor preoperatively by physical examination.
The benefit of extensive surgery is greater in the case of stage II tumors. In other word, the overall survival time of patients with these tumors is significantly higher than patients with more conservative surgery. In conclusion, in selected patients, advanced laparoscopic surgery performed by appropriately trained (e.g Lap Co training) and experienced staff in a center with sufficient patient numbers may be successful in the treatment of locally advanced tumors without compromising oncological principles.
Ethics
Informed Consent: Obtained.
Peer-review: Internally peer reviewed.
Authorship Contributions
Surgical and Medical Practices: M.U., G.M., Ö.Ö. Concept: M.U., C.D., Ö.D. Design: Ö.Ö., Ö.D., O.N. Data Collection or Processing: M.U., C.D., O.N., S.Ş. Video adition: M.U., C.D., Literature Search: Ö.D., G.M., Ö.Ö., Writing: M.U., Ö.D., Ö.Ö.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.