Abstract
Background
Ulcerative colitis (UC) is a chronic mucosal inflammatory bowel disease of the colon and rectum. After 10 years of having the disease, there is a significant risk of dysplasia or cancer in the affected colon and rectum, and because of the often aggressive biology of these tumors, frequent endoscopic surveillance is warranted. Over a third of patients with UC will ultimately require an operation, and although for specific cases alternative operations can be pursued, most patients prefer an ileal pouch-anal anastomosis (IPAA) with J-pouch construction.
Case
A staged IPAA removes the affected colon and rectum treating UC and also restores intestinal continuity. However, the standard colectomy for UC includes low ligations of the main colonic vascular pedicle branches (ileocolic, right colic, middle colic and inferior mesenteric) that does not address a proper oncologic operation. A high ligation of the named vessels as well as a proper resection of the affected colon with its mesentery and lymph node package are needed to treat colon cancer. Analogous to a total mesorectal exicision for rectal cancer, a more radical procedure to remove the tumor and lymph node packet for colon cancer is described as a complete mesocolic exision (CME) in efforts to increase disease free survival.
Discussion
We demonstrate a laparoscopic subtotal colectomy for UC, with an oncologic complete mesocolic excision for a left transverse colon carcinoma in the setting of chronic mucosal inflammation secondary to chronic UC as the first procedure in a 3-staged IPAA. In the video, it is also demonstrated how the lymph node dissection is extended towards the greater gastric curvature and comprising omentum and gastrocolic ligament. There were no postoperative complications in the 44-year old male patient.
Similar content being viewed by others
References
Heald R. The 'Holy Plane' of rectal surgery. Journal of the Royal Society of Medicine 1988; 81(9):503-508.
Maurer C, Renzulli P, Kull C, Kaser S, Mazzucchelli L, Ulrich L, Buchler M. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: Long-term results. Annals of surgical oncology 2011; 18: 1899-1906.
Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation- technical notes and outcome. Colorectal Disease 2009; 11(4):354-364.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Institutional Review Board (IRB)
We have obtained direct consent from the patient for publication of this work (as per policy of our institution).
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MP4 165122 KB)
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kessler, H., Cheong, J.Y. & Connelly, T.M. How to Do It: Laparoscopic Total Abdominal Colectomy with Complete Mesocolic Excision (CME) for Transverse Colon Cancer in Ulcerative Colitis. J Gastrointest Surg 27, 636–639 (2023). https://doi.org/10.1007/s11605-022-05526-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-022-05526-3