Laparosc Endosc Surg Sci . 2022; 29(4): 200-204 | DOI: 10.14744/less.2022.37790

Early term results of the left colic artery preservation in colorectal cancer surgery

Kuntay Kaplan¹, Cihan Gökler¹, Yusuf Murat Bað², Emrah Cengiz³, Fatih Sümer⁴, Cemalettin Aydýn³, Cüneyt Kayaalp^5
1Department of Gastrointestinal Surgery, Adana City, Training and Research Hospital, Adana, Türkiye
²Department of Gastrointestinal Surgery, Van Training and Research Hospital, Van, Türkiye
³Department of Gastrointestinal Surgery, Inonu University Faculty of Medicine, Malatya, Türkiye
⁴Department of Gastrointestinal Surgery, Irmet International Hospital, Tekirdag, Türkiye
⁵Private Gastrointestinal Surgery Clinic, Istanbul, Türkiye

INTRODUCTION: Colorectal cancer is a common type of cancer that causes significant morbidity and mortality. Post-resection anastomosis safety is important. The most important factor affecting anastomosis safety is blood accumulation in the anastomosis. In this study, we aimed to examine the early-term results of the preservation of the left colic artery (LCA) during laparoscopic anterior and low anterior resection (LAR) for the treatment of rectum and sigmoid colon cancers based on our clinical experience.
METHODS: A total of 192 archive files that were operated for rectum and sigmoid colon cancer in our center between April 2019 and October 2022 were reviewed retrospectively. The patients were diagnosed using colonoscopy and biopsy during the pre-operative period. The patients and their results were discussed in the oncology council, and the patients’ treatment plans were formed based on the council’s decision.
RESULTS: The patients’ mean age was 65.4±9.33 years and nearly half of them were males (n=8, 53.3%). Of the patients, 12 (80%) of them underwent LAR, while three patients (20%) underwent AR. The mean duration of surgery was 322.66±101.8 min, while the median bleeding amount was 50 (20–150) cc. One patient (6.7%) required reoperation due to an anastomotic leak, and abscess drainage was performed using the transanal method. No mortality was observed in patients at 30 days.
DISCUSSION AND CONCLUSION: In our study, the low ligation (LL) and LCA were preserved during laparoscopic AR and LARs for rectum and sigmoid colon cancers, preserving blood accumulation in the anastomosis. However, multicenter prospective randomized controlled studies are required to demonstrate whether LL significantly reduces anastomotic leaks.

Keywords: Colorectal cancer, Laparoscopy, Left colic artery

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Kolorektal Kanser Cerrahisinde Sol Kolik Arterin Korunmasýnýn Erken Dönem Sonuçlarý

Kuntay Kaplan¹, Cihan Gökler¹, Yusuf Murat Bað², Emrah Cengiz³, Fatih Sümer⁴, Cemalettin Aydýn³, Cüneyt Kayaalp^5
1Adana Þehir, Eðitim ve Araþtýrma Hastanesi, Gastrointestinal Cerrahi Kliniði, Adana
²Van Eðitim Ve Araþtýrma Hastanesi, Gastrointestinal Cerrahi Kliniði, Van
³Inönü Üniversitesi Týp Fakültesi, Gastrointestinal Cerrahi Kliniði, Malatya
⁴Uluslararasý Irmet Hastanesi, Gastrointestinal Cerrahi Kliniði, Tekirdað
⁵Özel Gastrointestinal Cerrahi Kliniði, Istanbul

GÝRÝÞ ve AMAÇ: Kolorektal kanserler, yaygýn olarak görülen, ciddi morbidite ve mortaliteye sebep olan kanser türüdür. Halen öncelikli tedavileri cerrahidir. Laparaskopik rezeksiyonlar, güvenle yapýlabilmektedir. Anastomozun güvenliðini etkileyen en önemli faktör, anastomozun kanlanmasýdýr. Bu çalýþmada, kendi klinik deneyimimizde, rektum ve sigmoid kolon kanseri tedavisi için laparoskopik anterior ve düþük anterior rezeksiyon sýrasýnda sol kolik arterin korunmasýnýn erken dönem sonuçlarýný incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Hastalarýn preoperatif dönemde tanýlarý kolonoskopi ve biyopsi ile konuldu. Hastalar ve sonuçlarý onkoloji konseyinde tartýþýlarak hastalarýn tedavi planý konsey kararýyla düzenlendi. Merkezimizde Nisan 2019- Ekim 2022 tarihleri arasýnda rektum ve sigmoid kolon kanseri nedeniyle opere edilen toplam 192 hastanýn dosyalarý retrospektif olarak incelendi.
BULGULAR: Hastalarýn ortalama yaþý 65.4 ± 9.33 yýldý ve yaklaþýk yarýsý erkekti (n=8, %53.3). Oniki hasta (%80) LAR, 3 hasta (%20) AR operasyonu geçirdi. Ortalama ameliyat süresi 322.66 ± 101.8 dakika idi ve ortanca kanama miktarý 50 (20-150) cc idi.. Bir hastada (%6.7) anastomoz kaçaðý ve buna baðlý reoperasyon ihtiyacý olmuþ ve transanal yöntemle abse drenajý yapýlmýþtýr. Hastalarda 30 günlük mortalite görülmemiþtir.
TARTIÞMA ve SONUÇ: Çalýþmamýzda rektum ve sigmoid kolon kanseri için yapýlan laparaskopik AR ve düþük anterior rezeksiyonlarda, düþük ligasyon ile sol kolik arter korunmuþ olup böylelikle, anastomozun kanlanmasý da korunmuþtur. Fakat düþük ligasyonun anastomoz kaçaklarýný anlamlý ölçüde azalttýðýný göstermek için, çok merkezli prospektif randomize kontrollü çalýþmalara ihtiyaç vardýr.

Anahtar Kelimeler: laparaskopi, kolorektal kanser, sol kolik arter

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