Laparoscopic Proximal Sigmoid Colon Cancer Surgery Using Surgical-Assisted CT Colonography

Objective: Preoperative understanding of the vascular morphology is important for preservation of the distal sigmoid colon and intraluminal processing of the mesentery in laparoscopic proximal sigmoid colon cancer surgery. We report a case of laparoscopic proximal sigmoid colon cancer surgery using sophisticated surgical-assisted CT colonography (CTC). The surgical-assisted CTC was created by combining a CTC created using SYNAPSE VINCENT and a vascular 3D-CT.

Methods: The patient was a woman in 80s with proximal sigmoid colon cancer, cT1bN0M0, cStage Ⅰ. The patient had a history of ascending colon cancer surgery. Contrast-enhanced CTC was performed preoperatively, and 3D-CT images(CTC, arterial 3D-CT, and venous 3D-CT)were created by Workstation(SYNAPSE VINCENT®, FUJIFILM).

Results: Using surgical-assisted CTC, D3 lymph node dissection, in which only the dominant artery, the first and second sigmoid colon artery, and its companion veins were processed, and enterotomy and mesenterotomy line at 10 cm on the oral and anal sides were simulated. Intraoperatively, surgery was performed as planned using surgical-assisted CTC as navigation images. The operative time was 197 minutes, and the blood loss was 30 g. The patient was discharged from the hospital on the 8th day without any postoperative complications. The pathological diagnosis was pT1bN0M0, pStage Ⅰ. There was no recurrence about 9 months after the surgery.

Conclusions: The sophisticated surgical-assisted CTC appeared to be useful in laparoscopic proximal sigmoid colon cancer surgery.