講演情報
[INTS5-2]A surgical case report of transverse colon cancer with lymph node metastasis invading into the superior mesenteric vein
*Takahiro Amano1, Tomokazu Okazaki1, Kanro Matsui1, Kazuya Niwa1, Tadaaki Shimizu2, Tomoki Shirota1, Kuniyuki Gomi1 (1. Department of Surgery, Suwa Red Cross Hospital, Japan, 2. Department of gastroenteorological surgery, The University of Shinshu)
[Case Report] An 85-year-old male was diagnosed with advanced transverse colon cancer with lymph node metastasis at the root of the middle colic vein, the lymph node invaded directly into the superior mesenteric vein (SMV); furthermore, liver metastases were detected in segments 7 and 3. The colon cancer staging was clinically T4a N2b M1a, Stage IVA.
[Surgical Findings] Robotic-assisted surgery was selected, beginning with a medial approach. Ligated the ileocecal artery and vein and the right branch of the middle colic artery, leaving the invading lymph node. The transverse mesocolon was resected, reaching the colon wall. Full mobilization of the hepatic flexure and dissecting the pre-pancreas plane up to the vicinity of the invading lymph node were performed; the terminal ileum and the colon were transected. Since resection of the tumor thrombus was deemed feasible, the procedure was converted to open surgery. The right gastroepiploic artery and vein were dissected, and the SMV was exposed at the inferior of the pancreas and taped. The root of the middle colic artery was transected, leaving only the tumor thrombus infiltrating the SMV. The distal SMV, the first and second jejunal veins, were taped and clamped with Satinsky forceps; the SMV was then released and excised along with the tumor thrombus. The SMV was reconstructed using end-to-end anastomosis with 5-0 monofilament suture. Since R0 resection of the primary tumor was achieved, we performed a simultaneous partial hepatectomy. The operative time was 8 hours and 42 minutes, with a console time of 3 hours and 8 minutes, and the amount of blood loss was 700 ml. He was discharged home on the 14th postoperative day, and underwent chemotherapy for recurrent liver metastasis, and finally died of the primary disease 2 years and 2 months postoperatively.
[Summary]We report a surgical case of transverse colon cancer with lymph node metastasis invading into the superior mesenteric vein, along with our considerations.
[Surgical Findings] Robotic-assisted surgery was selected, beginning with a medial approach. Ligated the ileocecal artery and vein and the right branch of the middle colic artery, leaving the invading lymph node. The transverse mesocolon was resected, reaching the colon wall. Full mobilization of the hepatic flexure and dissecting the pre-pancreas plane up to the vicinity of the invading lymph node were performed; the terminal ileum and the colon were transected. Since resection of the tumor thrombus was deemed feasible, the procedure was converted to open surgery. The right gastroepiploic artery and vein were dissected, and the SMV was exposed at the inferior of the pancreas and taped. The root of the middle colic artery was transected, leaving only the tumor thrombus infiltrating the SMV. The distal SMV, the first and second jejunal veins, were taped and clamped with Satinsky forceps; the SMV was then released and excised along with the tumor thrombus. The SMV was reconstructed using end-to-end anastomosis with 5-0 monofilament suture. Since R0 resection of the primary tumor was achieved, we performed a simultaneous partial hepatectomy. The operative time was 8 hours and 42 minutes, with a console time of 3 hours and 8 minutes, and the amount of blood loss was 700 ml. He was discharged home on the 14th postoperative day, and underwent chemotherapy for recurrent liver metastasis, and finally died of the primary disease 2 years and 2 months postoperatively.
[Summary]We report a surgical case of transverse colon cancer with lymph node metastasis invading into the superior mesenteric vein, along with our considerations.