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Minimally invasive surgery for colorectal cancer with persistent descending mesocolon: radiological findings and short-term outcomes

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Abstract

Background

Persistent descending mesocolon (PDM) is typically asymptomatic. However, features such as adhesion and variations in vessel anatomy could affect the surgical techniques for colorectal cancer (CRC). This study aimed to investigate the frequency and radiological features of PDM. Short-term outcomes after conventional laparoscopic surgery (CLS) for CRC with PDM were also investigated to assess the feasibility of CLS and identify strategies for minimally invasive surgery (MIS) in CRC with PDM.

Methods

Patients who underwent MIS, including CLS and robot-assisted laparoscopic surgery (RALS), for left-sided CRC between April 2016 and June 2019, were investigated. PDM was defined as the existence of the right border of the descending colon inside the right border of the left kidney based on preoperative computed tomography findings.

Results

Radiological findings of 837 patients were examined, and PDM was found in 19 (2.3%) patients. Radiality of the inferior mesenteric artery (IMA) was found in 5 of 19 (26.3%) PDM cases, which was significantly higher than that in non-PDM cases. The median lengths between the IMA and inferior mesenteric vein (IMV) and between the IMV and descending colon in PDM cases were 14.8 mm and 17.2 mm, respectively, which were significantly shorter than those in non-PDM cases. Short-term outcomes were evaluated only in CLS cases since the rate of hybrid surgery among RALS cases differed between non-PDM and PDM cases (0% vs. 44.4%), which would affect the surgical outcomes. The short-term outcomes in 447 CLS cases were similar between PDM and non-PDM cases. The frequency of extracorporeal division of the left colic artery (LCA) and IMV was significantly higher in PDM than in non-PDM cases (70.0% vs. 5.7%).

Conclusions

This radiological definition of PDM was feasible. CLS for left-sided CRC with PDM was feasible, and dividing the LCA and IMV extracorporeally would be vital for safe surgery.

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References

  1. Morgenstern L (1960) Persistent descending mesocolon. Surg Gynecol Obstet 110:197–202

    CAS  PubMed  Google Scholar 

  2. Popky GL, Lapayowker MS (1966) Persistent descending mesocolon. Radiology 86:327–331

    Article  CAS  Google Scholar 

  3. Tsuruta A, Kawai A, Oka Y, Okumura H, Matsumoto H, Hirai T, Nakamura M (2014) Laparoscopic right hemicolectomy for ascending colon cancer with persistent mesocolon. World J Gastrotenterol 20:5557–5560

    Article  Google Scholar 

  4. Okada I, Yamaguchi S, Kondo H, Suwa H, Tashiro J, Ishii T (2013) Laparoscopic colectomy for persistent descending mesocolon: an experience of 13 patients (in Japanese). J Jpn Soc Endosc Surg 18:459–464

    Google Scholar 

  5. Ogihara M, Kawamura YJ, Minami M, Watanebe T, Sunami E, Matsuda K, Masaki T, Muto T (2000) Primary intestinal obstruction complicated by persistent descending mesocolon. Int Surg 85:226–230

    CAS  PubMed  Google Scholar 

  6. Ongom PA, Lukande RL, Jombwe J (2013) Anal protrusion of an ileocolic intussusception in an adult with persistent ascending and descending mesocolon: a case report. BMC Res Notes 6:1

    Article  Google Scholar 

  7. Chen A, Yang FS, Shin SL, Sheu CY (2003) CT diagnosis of volvulus of the descending colon with persistent mesocolon. AJR Am J Roentgenol 180:1003–1006

    Article  Google Scholar 

  8. Mori Y, Higuchi I, Tanigawa T, Ishikawa A, Hosomi S, Urano N, Akiyama Y, Gofuku J, Hasuike Y (2018) Laparoscopy-Assisted Surgery for Descending Colon Cancer in a Patient with Persistent Descending Mesocolon-A Case Report. Gan To Kagaku Ryoho 45:1833–1835

    PubMed  Google Scholar 

  9. Hisano K, Ueki T, Kono H, Ikenaga N, Maeyama R, Konomi H, Okido M, Yamashita N, Motoshita J, Ichimiya H (2018) Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolon: a case report. Asian J Endosc Surg 12:329–333

    Article  Google Scholar 

  10. Arai S, Nishimura Y, Kazama S, Nishizawa Y, Ishikawa H, Mori Y, Takenoya T, Takano M (2016) A case of laparoscopic sigmoidectomy for a patient with persistent descending mesocolon. Jpn J Cancer Chemother 43:1806–1808

    Google Scholar 

  11. Yamaguchi T, Kinugasa Y, Shiomi A, Tomioka H, Kagawa H, Yamakawa Y (2016) Robotic-assisted vs. conventional laparoscopic surgery for rectal cancer: short-term outcomes at a single center. Surg Today 46:957–962

    Article  Google Scholar 

  12. Shiomi A, Kinugasa Y, Yamaguchi T, Kagawa H, Yamaoka Y (2016) Robot-assisted versus laparoscopic surgery for lower rectal cancer: the impact of visceral obesity on surgical outcomes. Int J Colorectal Dis 31:1701–1710

    Article  Google Scholar 

  13. Kojima T, Hino H, Kagawa H, Yamaoka Y, Manabe S, Hanaoka M, Kato S (2020) Surgical Outcomes of Laparoscopic and Open D3 Dissection for Clinical Stage II/III Descending Colon Cancer. Anticancer Res 40:1731–1737

    Article  Google Scholar 

  14. UICC. TNM classification of malignant tumours eighth edition (2017) Wiley, New York

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  16. Kanda Y (2013) Investigation for the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  Google Scholar 

  17. Fujii S, Ishibe A, Ota M, Suwa H, Watanabe J, Kunisaki C, Endo E (2019) Short-term and long-term results of a randomized study comparing high tie and low tie inferior mesenteric artery ligation in laparoscopic rectal anterior resection: subanalysis of the HTLT (high tie vs. low tie) study. Surg Endosc 33:1100–1110

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan

    Marie Hanaoka, Hitoshi Hino, Akio Shiomi, Hiroyasu Kagawa, Shoichi Manabe, Yusuke Yamaoka & Shunichiro Kato

  2. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Marie Hanaoka & Yusuke Kinugasa

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  1. Marie Hanaoka
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  2. Hitoshi Hino
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  3. Akio Shiomi
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  4. Hiroyasu Kagawa
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  5. Shoichi Manabe
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  6. Yusuke Yamaoka
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  8. Yusuke Kinugasa
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Correspondence to Hitoshi Hino.

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Drs. Marie Hanaoka, Hitoshi Hino, Akio Shiomi, Hiroyasu Kagawa, Shoichi Manabe, Yusuke Yamaoka, Shunichiro Kato, and Yusuke Kinugasa have no conflicts of interest or financial ties to disclose.

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Hanaoka, M., Hino, H., Shiomi, A. et al. Minimally invasive surgery for colorectal cancer with persistent descending mesocolon: radiological findings and short-term outcomes. Surg Endosc 35, 2797–2804 (2021). https://doi.org/10.1007/s00464-020-07713-2

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  • DOI: https://doi.org/10.1007/s00464-020-07713-2

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