To investigate the safety and feasibility and clinical outcome of laparoscopic complete mesocolic excision (CME) for left colon cancer at splenic flexure based on membrane anatomy.

From Jan 2016 to Jun 2019, 33 patients with left colon cancer at splenic flexure were enrolled in the present study, who underwent laparoscopic CME, and their clinical data were analyzed retrospectively. All of 33 patients received preoperative colonoscope and the lesions were labeled by using nano carbon and/or titanium clip, eventually they were all diagnosed by biopsy and pathological examination. The lesions were confirmed to be located at splenic flexure by preoperative examinations of abdominal enhanced CT and/or standing abdominal X-ray. There were 5 cases of stage Ⅰ, 19 cases of stage Ⅱ and 9 cases of stage Ⅲ in preoperative TNM staging evaluation. Based on the theories of membrane anatomy and CME, the operations were carried out by using a combined cephalic-middle-lateral approach. The roots of left colon artery, left branch of middle colon artery and inferior mesenteric vein were ligated and cut off respectively, then the 223 and 253 lymph nodes were dissected. Measurement data such as general data of patients, operation parameters and postoperative rehabilitation data were expressed as (±s). The incidence of postoperative complications were expressed as %. Statistical analysis were performed by using SPSS 20.0 software.

All of 33 patients receive successful laparoscopic left colectomy without conversion, with the operation time of (160.0±25.4)min and intraoperative blood loss of (70.6±46.4)ml. The number of harvested lymph nodes were (19.3±3.2) and the length of specimens were (23.0±2.8) cm. Rapid recovery of patients were observed with the first exhaust time of(4.5±1.2) d, the oral feeding time of (5.5±1.3) d and postoperative hospital stay of(7.8±1.1) d. There were 4 cases of stage Ⅰ, 21 cases of stage Ⅱ and 8 cases of stage Ⅲ in postoperative TNM staging evaluation. There were 2 cases of inflammatory ileus after operation, who recovered after conservative treatment. No postoperative abdominal bleeding and anastomotic complications occurred. All the patients survived without tumor recurrence and metastasis during the followed-up of 8~49 months (median follow-up time of 26 months).

Based on the theories of membrane anatomy, for colon cancer at splenic flexure, the cephalic-middle-lateral approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision. It appears to be safe and feasible and could be a promising method for selected patients with left colon cancer.