[Laparoscopic Right Hemicolectomy after the Partial Colectomy of the Transverse Colon with Useful Surgery- Assisted CT Colonography].

BACKGROUND AND PURPOSE: Surgery-assisted CT colonography(CTC), a synthesis of CTC and vascular 3D-CT, is gaining recognition for its usefulness in colorectal cancer surgery. We report a laparoscopic right hemicolectomy after partial colectomy of the transverse colon in which sophisticated surgery-assisted CTC was useful.

PATIENT AND METHOD: The patient was a woman in 90s with ascending colon cancer, cT3N0M0, cStage Ⅱa. The patient had a history of open partial colectomy of the transverse colon for transverse colon cancer. Laterally spreading tumor(LST)was also present in the transverse colon. Surgery-assisted CT consisting of CTC, arteriovenous 3D-CT, and pancreas-duodenum 3D-CT was created by workstation (SYNAPSE VINCENT®, FUJIFILM).

RESULT: Ascending colon cancer, LST, and anastomosis were all identifiable by CTC. Using arteriovenous 3D-CT, it was possible to identify the dominant arteries, the ileocolic artery(ICA)and right colic artery(RCA), the ileocolic vein(ICV)and 2 accessory right colic veins(ARCV)that accompany the right and left branches of the RCA, and the middle colic artery defect. A laparoscopic right hemicolectomy of the colon D3 lymph node dissection was simulated with a combined resection of the LST and anastomosis and dissection of the ICA, ICV, RCA, and 2 ARCV. The surgery was performed as simulated using navigation images with surgery-assisted CTC corrected to the intraoperative field of view. Pancreatic-duodenal 3D-CT facilitated identification of vessels. The operative time was 299 minutes, and the blood loss was 5 g. The patient was discharged from the hospital on the 8th day without any postoperative complications. The pathological diagnosis was pT2N0M0, pStage Ⅰ for the ascending colon cancer and tubular adenoma for the LST, and the anastomosis was also resected. There was no recurrence about 9 months after the surgery.

CONCLUSION

The sophisticated surgery- assisted CTC enabled the identification of anastomoses and residual vessels with previous surgery, and was useful in determining the extent of dissected vessels and bowel resection.