Abstract
Abstract
Background
Anastomotic recurrence of colorectal cancer is rare, but reoperation improves prognosis. However, there is no clear evidence regarding the extent of dissection, and there are few reports on the details of surgery. We used intraoperative lymphatic flow imaging with indocyanine green (ICG) fluorescence as a reference to determine the range of additional resection.
Case presentation
The patient was a 75-year-old man who underwent laparoscopic right hemicolectomy and extracorporeal functional terminal anastomosis for ascending colon cancer 4 years ago. Histopathological examination revealed a well-differentiated tubular adenocarcinoma, T4aN0M0, pathological stageIIB. During follow-up, anemia was observed, and colonoscopy indicated anastomotic recurrence, so additional laparoscopic resection was performed. Intraoperatively, ICG was injected into the anastomotic site, and the operation proceeded under near-infrared light observation. Lymphatic vessels along the middle colonic artery were visualized down to the root of the vessel. Using this as an indicator, the vessel was ligated from the root. Using the fact that the lymphatic vessels were also depicted in the small intestinal mesentery on the oral side of the anastomosis as an indicator, the small intestine and mesentery were resected about 7 cm from the anastomosis.
Conclusions
The optimal surgical approach for anastomotic recurrence of colorectal cancer has not been defined. Intraoperative ICG fluorescence imaging can provide images of lymphatic flow from the site of recurrence and may be an indicator of lymph node dissection in the case of anastomotic recurrence.
Publisher
Springer Science and Business Media LLC
Subject
Industrial and Manufacturing Engineering,General Business, Management and Accounting,Materials Science (miscellaneous),Business and International Management
Reference18 articles.
1. Hirayama K, Mori Y, Iino H, et al. An examination of anastomotic recurrence after resection of colon cancer with functional end-to-end anastomosis. J Jpn Coll Surg. 2015;40:1132–9.
2. Futami R, Shimanuki K, Sugiura A, Tsuchiya Y, Kaneko M, Okawa K, et al. Recurrence of colonic cancer twice at the site of stapled colorectal anastomosis. J Nippon Med Sch. 2007;74:251–6.
3. Gertsch P, Baer HU, Kraft R, Maddern GJ, Altermatt HJ. Malignant cells are collected on circular staplers. Dis Colon Rectum. 1992;35:238–41.
4. Kyzer S, Gordon PH. The stapled functional end-to-end anastomosis following colonic resection. J Colorectal Dis. 1992;7:125–31.
5. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42.