VM91 - Laparoscopic Left Hemicolectomy with Apical Lymph Node Dissection

Purpose/Background: Splenic flexure and descending colon tumors account for 4 to 8% of all colorectal cancers treated surgically. They are associated with poorer prognosis, advanced stage at presentation with higher risk of obstruction and lymphatic invasion. Complete mesocolic excision can be performed laparoscopically to achieve good oncologic outcomes with minimal morbidity.

Methods/Interventions: This is case of a 54-year-old female with a bulky descending colon tumor and multiple enlarged mesocolic nodes seen on staging scans. There were no distant metastases. Laparoscopic left hemicolectomy was performed with apical node dissection. After medial to lateral mesocolic mobilization, the origin of the inferior mesenteric artery (IMA) was identified. Lymphatic tissue was excised from the root of the IMA to the left colic artery with preservation of the superior rectal and sigmoid arteries.

Results/Outcomes: The patient recovered well and discharged on postoperative day 5. The final histology had 42 lymph nodes and the apical lymph node was negative for metastases. She remains disease free after 1 year.

Conclusion/Discussion: Left hemicolectomy with apical node dissection is technically challenging but can be safely performed laparoscopically with good oncological outcomes.