Annals of Surgical Oncology

Totally Laparoscopic Transluminal Resection Versus Combined Laparo-Endoscopic Technique for Removal of Iuxta-Cardial Gastric Stromal Tumors

ASO Author Reflections: Understanding Recurrence Patterns and Time Courses of Intrahepatic Cholangiocarcinoma After Surgery Helps in Postoperative Surveillance and Treatment

How Old is Too Old to Operate for Mesothelioma?

Sentinel Node Biopsy After Neoadjuvant Systemic Therapy for Breast Cancer: The Method Matters

ASO Author Reflections: Managing Symptoms at the End-of-Life—Some Progress, Many Unanswered Questions

Laparoscopic Complete Mesocolic Excision for Double Flexural Colon Cancers Abstract Background Laparoscopic complete mesocolic excision (CME) for hepatic or splenic flexural colon cancer is considered technically demanding. The double (hepatic and splenic) flexural colon cancers are rare, and the laparoscopic CME procedure for such disease is not standardized. Methods This video presents laparoscopic CME for double (hepatic and splenic) flexural colon cancers using a medial and cranial approach. Results The patient was a 60-year-old woman with the diagnosis of splenic flexure cancer (cT4N1M0) and hepatic flexure cancer (cT3N0M0). Laparoscopic subtotal colectomy was performed. First, the left colic artery was divided at its origin, and the inferior mesenteric vein also was divided at the same level. The descending mesocolon was widely separated from the retroperitoneal tissues using a medial approach. Then, lymph node dissection along the surgical trunk was performed using a cranial approach. Finally, the transverse mesocolon was divided at the inferior border of the pancreas, and CME was achieved. The specimen was extracted through a small incision at the umbilicus, and side-to-side ileo-sigmoid anastomosis was performed extracorporeally. Conclusions The approach presented in the video might be useful for standardization of laparoscopic CME for double flexural colon cancers.

Does a Lymph Node-Based Model Predict Clinical Value for Adjuvant Therapy in Squamous Cell Carcinoma of the Esophagus Treated With Upfront Surgery?

The Pelvis-First Approach for Robotic Proctectomy in Patients with Redundant Abdominal Colon Abstract Background Robotic surgery is increasingly performed for low rectal cancer.1 A redundant sigmoid colon makes retraction and pelvic dissection challenging. We present a 'pelvis-first' approach to robotic proctectomy where pelvic dissection occurs prior to colonic mobilization. Methods A 26-year-old woman was diagnosed with a clinical T3N1 rectal adenocarcinoma at 3 cm from the anal verge. The patient had Lynch syndrome, with a germline mutation in the PMS2 gene. A near-complete clinical response was observed after neoadjuvant chemoradiation (NCRT), and the patient wished to delay surgery and permanent colostomy. Additional FOLFOX was administered and led to a complete clinical response. After 2.5 months of watchful delay of surgery, the tumor regrew, and the patient then underwent robotic abdominoperineal resection (APR). Results Initial exploration revealed a highly redundant sigmoid colon. A pelvis-first approach was undertaken. The colon was left tethered and outside of the pelvis during the pelvic dissection. The levator ani was divided transabdominally. Vascular dissection and left colon mobilization were completed after pelvic dissection.2 The specimen was removed transanally, obviating the need for abdominal incision. An end colostomy was created laparoscopically, and the perineum was closed primarily after omental flap. The patient recovered without complications. Conclusions The 'pelvis-first' approach to proctectomy is advantageous for patients with a highly redundant sigmoid colon. Transabdominal division of the levator ani during APR ensures excellent circumferential margin. Although Lynch syndrome-associated rectal cancer can show excellent response to NCRT,3 patients undergoing watchful delay of surgery require close monitoring and prompt triggering of salvage proctectomy when tumor regrowth is observed.4,5

ASO Author Reflections: International Experience of Isolated Limb Infusion for Melanoma Shows Durable Response

ASO Author Reflections: Tending Towards a Personalized Medicine for Colorectal Carcinomatosis by Adding the RAS Mutation Status in the Workup for CRS and HIPEC

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com