Laparoscopic Radical Transverse Colon Cancer Resection with Transrectal Specimen Extraction

Abstract

Consensus regarding the choice of surgical method for transverse colon cancer (TCC) has not yet been achieved. Based on the tumor location, conventional surgical methods involve laparoscopic extended right hemicolectomy or left hemicolectomy. Nevertheless, systematic reviews and meta-analyses on the surgical methods for TCC have reported that local resection with proximal and distal resection margins of 10 cm from the tumor is safe and feasible and produces comparable oncological outcomes to extended right/left hemicolectomy. Therefore, patients with TCC can undergo laparoscopic radical TCC resection with transrectal specimen extraction. The key operative feature of this procedure is the intra-abdominal mobilization of the hepatic or splenic flexures, which may be carried out up to the ileocecal region. There are two main challenges associated with this procedure. The first challenge involves common key techniques required for all laparoscopic surgeries, including the correct identification of anatomical landmarks, a rational surgical approach, complete mesenteric resection, ligation at the roots of mesenteric vessels, lymph node dissection, and visualization and protection of important tissues and organs. The second challenge, which is unique to natural orifice specimen extraction surgery, occurs during total laparoscopic digestive tract reconstruction; in these cases, the laparoscopic creation of an overlapped delta-shaped anastomosis using a stapler is required, which is more technically challenging than other anastomosis procedures. Therefore, this procedure requires strict adherence to the indications, clear surgical thinking, and proficiency in surgical skills. In this chapter, we describe a case of laparoscopic radical TCC resection with transrectal specimen extraction as an example.