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Primary cancer of the ileum is rare, and when it occurs in conjunction with primary colon cancer, it becomes even more infrequent and challenging to diagnose prior to surgical intervention. Primary small bowel cancers can be overlooked and may be misidentified as small bowel mesenchymal tumours or advanced metastases from colon cancer. We present an exceedingly uncommon case of ruptured primary ileal cancer combined with primary descending colon cancer presenting with gastrointestinal bleeding. Based on our understanding, instances of dual tumours concurrently occurring are exceedingly infrequent. In this patient, there was a preoperative suspicion of bleeding from colon cancer in the descending region. However, intraoperative exploration revealed that the location of the bleeding was a terminal ileal mass. Following the surgical intervention, the patient recovered satisfactorily. Intraoperative exploration of the entire gastrointestinal tract is therefore necessary in patients with gastrointestinal haemorrhage, especially in those who require urgent surgery without adequate preoperative investigations. If a mass is detected at the end of the ileum, intraoperative pathology should be performed if feasible. Subsequently, if the diagnosis reveals an adenocarcinoma, terminal ileocolic resection and right hemicolectomy are necessary for appropriate resection.

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PURPOSE: This study aimed to compare the short- and long-term outcomes of laparoscopic D3 lymph node (LN) dissection between ligation of the inferior mesenteric artery (IMA) (LIMA) and preservation of the IMA (PIMA) for descending colon cancer using propensity score-matched analysis. METHODS: This retrospective study included 101 patients with stage I-III descending colon cancer who underwent laparoscopic D3 LN dissection with LIMA (n = 60) or PIMA (n = 41) at a single center between January 2005 and March 2022. After propensity score matching, 64 patients (LIMA, n = 32; PIMA, n = 32) were included in the analysis. The primary endpoint was the long-term outcomes, and the secondary endpoint was the surgical outcomes. RESULTS: In the matched cohort, no significant difference was noted in the surgical outcomes, including the operative time, estimated blood loss, number of harvested LNs, number of harvested LN 253, and complication rate. The long-term outcomes were also not significantly different between the LIMA and PIMA groups (3-year recurrence-free survival, 72.2% vs. 75.6%, P = 0.862; 5-year overall survival, 69.8% vs. 63.4%, P = 0.888; 5-year cancer-specific survival, 84.2% vs. 82.8%, P = 0.607). No recurrence of LN metastasis was observed around the IMA root. CONCLUSION: Laparoscopic D3 dissection in PIMA was comparable to that in LIMA regarding both short- and long-term outcomes. The optimal LN dissection for descending colon cancer should be investigated in future large-scale studies.

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BACKGROUND: Single-incision laparoscopic complete mesocolic excision with central vascular ligation for descending colon cancer is technically challenging. Standardization of the surgical procedures is therefore needed. METHODS: In a Trendelenburg position with left side elevated, the sigmoid mesocolon is mobilized using a medial-to-lateral approach, and the left colic artery and inferior mesenteric vein (IMV) are divided after radical lymphadenectomy along the inferior mesenteric artery, preserving the superior rectal artery. The descending mesocolon is mobilized from the retroperitoneal planes up to the dorsal surface of the pancreas using medial and lateral approaches. Next, changing the surgical position to a reverse Trendelenburg position with left side elevated, the omental bursa is opened, and the transverse mesocolon is separated from the inferior border of the pancreas. The splenocolic ligament and lateral attachment are then divided, matching the previous medial dissection of the retroperitoneum, and the splenic flexure is fully mobilized. The IMV is divided again at the inferior border of the pancreas. The left branch of the middle colic artery is also divided. RESULTS: Forty-seven consecutive patients with DCC underwent single-incision laparoscopic CME with CVL. One patient required an additional port. Median operative time, blood loss, and number of harvested lymph nodes were 240 min (interquartile range [IQR], 195-257 min), 5 mL (IQR, 5-52 mL), and 21 (IQR, 13-29), respectively. Morbidity rate was 5.9%. Median duration of hospitalization was 9 days (IQR, 7-11 days). CONCLUSIONS: Single-incision laparoscopic CME with CVL is safe and feasible for DCC.

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The treatment strategy for colon cancer with liver metastasis has always been a great challenge for clinical surgeons.Single treatment method such as surgical resection or systemic chemotherapy can no longer meet the treatment needs of such patients.With the extensive development of the multi-disciplinary team(MDT)for colorectal cancer based on surgery,more and more patients with advanced colorectal cancer have obtained better treatment effects and survival benefits.A case of descending colon cancer with huge hepatic metastasis diagnosed and treated by a multi-disciplinary team was reported,aiming to provide reference for clinical practice.

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An 89-year-old male came to the hospital with a complaint of abdominal distension. Abdominal computed tomography showed wall thickening in the descending colon and marked dilatation of the proximal colon, and lower gastrointestinal endoscopy demonstrated a stenosis in the descending colon. Although a biopsy from the stenotic lesion showed calcified eggs of Schistosoma japonicum with no malignant findings, we suspected malignant involvement, so we performed a descending colectomy with regional lymph node dissection. Pathological examination revealed a moderately differentiated adenocarcinoma. The colon cancer was diagnosed as pT4bN0M0, Stage IIc. The patient's history as a resident of one of the formerly endemic areas of Japan suggests that he may have carried S. japonicum for a long time, and that it may have contributed to carcinogenesis.

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BACKGROUND: Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer is an essential procedure for improved oncologic outcomes after surgery. Laparoscopic surgery for splenic flexure colon cancer was recently adopted due to a greater understanding of surgical anatomy and improvements in surgical techniques and innovative surgical devices. METHODS: We retrospectively analyzed the data of patients with splenic flexure colon cancer who underwent laparoscopic CME with CVL at our institution between January 2005 and December 2017. RESULTS: Forty-five patients (4.8%) were enrolled in this study. Laparoscopic CME with CVL was successfully performed in all patients. The median operative time was 178 min, and the median estimated blood loss was 20 g. Perioperative complications developed in 6 patients (13.3%). The median postoperative hospital stay was 9 days. According to the pathological report, the median number of harvested lymph nodes was 15, and lymph node metastasis developed in 14 patients (31.1%). No metastasis was observed at the root of the middle colic artery or the inferior mesenteric artery. The median follow-up period was 49 months. The cumulative 5-year overall survival and disease-free survival rates were 85.9% and 84.7%, respectively. The cancer-specific survival rate in stage I-III patients was 92.7%. Recurrence was observed in 5 patients (11.1%), including three patients with peritoneal dissemination and two patients with distant metastasis. CONCLUSIONS: Laparoscopic CME with CVL for splenic flexure colon cancer appears to be oncologically safe and feasible based on the short- and long-term outcomes in our study. However, it is careful to introduce this procedure to necessitate the anatomical understandings and surgeon's skill. The appropriate indications must be established with more case registries because our experience is limited.

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BACKGROUND: Complete mesocolic excision with central vascular ligation is a standard advanced technique for achieving favorable long-term oncological outcomes in colon cancer surgery. Clinical evidence abounds demonstrating the safety of high ligation of the inferior mesenteric artery (IMA) for sigmoid colon cancer but is scarce for descending colon cancer. A major concern is the blood supply to the remnant distal sigmoid colon, especially for cases with a long sigmoid colon. We sought to clarify the safety and feasibility of high ligation of the IMA in surgery for descending colon cancer using indocyanine green (ICG) fluorescence imaging. METHODS: In this prospective single-center pilot study, we examined 20 patients with descending colon cancer who underwent laparoscopic colectomy between April 2018 and September 2019. Following full mobilization and division of the proximal colonic mesentery, we temporarily clamped the root of the IMA and performed ICG fluorescence imaging of the blood flow to the sigmoid colon. The postoperative anastomosis-related complications (primary endpoint) and length of viable remnant colon, and the number of lymph nodes retrieved (secondary endpoints) were evaluated and compared with historical controls who underwent conventional IMA-preserving surgery (n = 20). RESULTS: Blood flow reached 40 (17-66) cm retrograde from the peritoneal reflection, even after IMA clamping. Accordingly, IMA high ligation was performed in all cases. No anastomotic anastomosis-related complications occurred in each group. Retrieved total lymph nodes were higher in number in the ICG-guided group than in the conventional group (p = 0.035). Specifically, more principal nodes were retrieved in the ICG-guided group, compared with the conventional group (p = 0.023). However, the distal margin was not as long compared with the conventional group. CONCLUSION: We demonstrated the safety and feasibility of high ligation of the IMA for descending colon cancer without sacrificing additional distal colon using fluorescence evaluation of blood flow in the remnant colon.

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BACKGROUND: What qualifies as optimal lymph node (LN) dissection in the surgical management of splenic flexure colon cancer (SFCC) still remains controversial because few studies have evaluated the distribution of LN metastasis of SFCC. The aim of this study was to clarify detailed distribution of LN metastasis and long-term outcomes of SFCC. METHODS: This retrospective study enrolled patients who had curative colectomy for primary transverse or descending colon cancer of pathological stage I, II, or III at a single high-volume cancer center between April 2002 and December 2018. The 538 eligible patients were divided into three groups: patients with SFCC (SFCC group, n = 168), patients with proximal transverse colon cancer (PTCC group, n = 290), and patients with distal descending colon cancer (DDCC group, n = 80). LNs were classified into horizontal (pericolic) and vertical (intermediate and main) nodes. Intermediate and main LN station numbers were defined according to the Japanese Society for Cancer of the Colon and Rectum classification. Distributions of LN metastasis and long-term outcomes were compared. RESULTS: In the SFCC group, the mean age was 67.3 ± 10.5 years and 110 patients (65.5%) were male. The proportion of patients with LN metastasis in the intermediate or main region was significantly lower in the SFCC group (8%) than in the PTCC (37%) (p < 0.01) or DDCC group (29%) (p < 0.01) in pathological stage III patients. In the SFCC group, the incidence of pericolic LN metastasis on the oral side of tumor (43%) was significantly higher than in the PTCC group (21%) (p < 0.01) and was similar to that in the DDCC group (42%) (p = 0.51), while in the SFCC group, the incidence of pericolic LN metastasis on the anal side of tumor (17%) was lower than in the PTCC group (31%) and was also similar to that in the DDCC group (21%). There were no significant differences in disease-specific survival rates among all groups. CONCLUSIONS: LN metastasis occurred mainly in the pericolic region, especially on the oral side of the tumor in SFCC. It may, therefore, be important to have an adequate bowel resection margin, especially on the oral side, for SFCC.

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AIM: To compare the surgical outcomes of laparoscopic colectomy (LAC) with Japanese D3 dissection for descending colon cancer (DCC) with those of open colectomy (OC). PATIENTS AND METHODS: Seventy-two patients who underwent OC or LAC with D3 dissection for clinical stage II/III DCC between September 2002 and June 2019 were evaluated in terms of short-term outcomes. The long-term outcomes of the 59 patients who underwent surgery between September 2002 and June 2016 were evaluated. RESULTS: Twenty-six patients underwent OC and 46 patients underwent LAC. The blood loss was significantly less in the LAC group. The complication rate was similar in both groups. The rates of 5-year overall survival (95.8% in the OC group vs. 89.9% in the LAC group) and relapse-free survival (79.2% in the OC group vs. 82.1% in the LAC group) were similar in both groups. CONCLUSION: LAC is an acceptable treatment option for stage II/III DCC.

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BACKGROUND: The optimal extent of lymph node dissection in patients with descending colon cancer is still debatable. We designed this study to evaluate the distribution of lymph node metastasis and the appropriate extent of lymph node dissection in descending colon cancer patients. METHODS: We retrospectively reviewed the medical records of 118 descending colon cancer patients without distant metastasis, who underwent curative resection between January 2004 and December 2014. The distribution of lymph node metastasis was evaluated, and prognostic factors were analysed. RESULTS: The median follow-up period was 52 months (range 1-125 months). Twenty-six (22.0%) patients underwent high ligation of the inferior mesenteric artery (IMA), whereas 92 (78.0%) patients underwent ligation of the left colic artery, saving the IMA. Lymph nodes at the origin of the IMA showed no metastasis in any of the 26 patients who underwent high ligation of the IMA. After propensity score matching, 3-year disease-free survival (80.4% versus 92.9%, P = 0.471) and 5-year overall survival (81.8% versus 90.9%, P = 0.875) were not significantly different according to the type of IMA ligation. CONCLUSION: In patients with descending colon cancer, there was no lymph node metastasis at the origin of the IMA, and ligation of the IMA showed no prognostic benefit.

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BACKGROUND: The safety and efficacy of laparoscopic surgery for transverse and descending colon cancer remain controversial. This study aimed to evaluate the short- and long-term outcomes of this procedure. METHODS: We conducted a single-institutional randomized controlled trial. Patients with transverse or descending colon cancer were randomly allocated to receive laparoscopic surgery (LAC) or conventional open surgery (OC). The primary endpoint was the overall complication rate between the two groups. The secondary endpoints were the length of the postoperative hospital stay, the health-related quality of life (HRQOL) score (at 1, 6, and 12 months after surgery), the 5-year relapse-free survival (RFS), and the 5-year overall survival (OS). RESULTS: Between August 2008 and October 2012, a total of 66 patients were enrolled (33 in the LAC group and 33 in the OC group). The patient characteristics showed no significant differences between the two groups. The complication rates (≥ grade 3) were 6.1% in the LAC group and 12.1% in the OC group (p = 0.392). The length of postoperative stay was not significantly different between the two groups. Regarding the HRQOL, the physical functioning, role physical, bodily pain, social functioning, mental health, and role component summary at 1 month after surgery and the social functioning and mental health at 6 months after surgery were better in the LAC group than in the OC group. The 5-year RFS and OS rates were similar between the LAC and OC groups (RFS 90.5% and 87.3%, respectively, p = 0.752; OS 93.3% and 100.0%, respectively, p = 0.543). CONCLUSIONS: The short- and long-term outcomes of laparoscopic surgery for transverse and descending colon cancer are almost equal to those of open surgery. Laparoscopic resection is a better choice than open surgery for managing this cancer with regard to the short- and mid-term QOL. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01861691 .

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BACKGROUND: Necrotizing fasciitis (NF) caused by colorectal cancer is rare, and very few cases associated with colon cancer have been reported. We describe the case of a patient with NF in the left thigh due to penetration of descending colon cancer who was treated with one-stage surgical resection without creating a stoma. CASE PRESENTATION: An 80-year-old woman was brought to our hospital complaining of fever and difficulty with body movement. A physical examination showed subcutaneous emphysema from the left lower abdomen to the left femoral region. CT showed abscess formation with emphysema around the descending colon, and the wall of the descending colon was thickened, which led to suspicion of colon cancer. The patient was subsequently diagnosed with NF due to penetration of descending colon cancer. Left hemicolectomy and open drainage of the left femoral region was performed. The histopathological findings were well-differentiated adenocarcinoma, with the tumor grown through the serosa (T4a) and with no metastasis to lymph nodes (N0). After surgery, the patient received intensive care for septic shock and lavage of the open drainage site, and sepsis was controlled progressively. After closure of the drainage site, the patient was transferred to a different hospital at 26 days after surgery, and she has had 6-month relapse-free survival. CONCLUSIONS: In NF caused by colon cancer, early one-stage resection may improve the oncological outcome. Physical status should be assessed carefully, and one-stage resection should be considered if the patient has the capacity to undergo this procedure.

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BACKGROUND: The splenic flexure (SF) anatomy is complex due to multiple vessels, surrounding organs, layers, and irregular adhesions [1-3]. METHODS: Our laparoscopic approach involves a lateral-to-medial approach to the left-sided transverse mesocolon (TM), a medial-to-lateral approach to the left mesocolon (LM), and take-down of the remnant SF. First, the omental bursa is opened and its posterior wall and the anterior layer of the TM are dissected along the pancreas, where a gauze is placed. The TM is spread cephalad. A window in the TM is opened in the gauze seen through the TM. If necessary, the middle colic vessels are divided with lymph node (LN) dissection. Then the left colic artery is divided with LN dissection using a medial approach. The LM is widely dissected from the retroperitoneum to reach the TM window. While observing the pancreas through the window, the LM and TM are divided from the pancreas close to the SF. The descending colon is mobilized from its lateral attachment. Finally, the SF is taken down from the spleen by separating remnant structures, including adhesions. Subsequently, functional end-to-end anastomosis was performed extracorporeally. RESULTS: During March 2012-December 2016, 39 patients with left-sided transverse or descending colon cancer underwent this treatment. The mean operative time, blood loss, number of harvested LNs, and hospital stay duration were 283 min, 45 ml, 15, and 9 days, respectively. No patient needed conversion to open surgery or had organ injury, anastomotic leakage, or Clavien-Dindo III-V complications. There were 7/13/18/1 patients with Stage I/II/III/IV colon cancer, respectively. Nineteen cases had positive LNs. All patients were alive with one local and two distant recurrences at a mean 24-month follow-up. CONCLUSIONS: This is a safe and effective surgical strategy for treating colon cancer of the SF, strategically designed to resect the SF after dissecting the surrounding structures.

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INTRODUCTION: Previous randomized controlled trials demonstrated similar oncological outcomes between laparoscopic and open colectomies, except for cases involving transverse colon and splenic flexure colon cancer. The objective of this study was to confirm the oncological safety and advantages of the short-term results of laparoscopic surgery for transverse and descending colon cancer in comparison with open surgery. METHODS: The study data were retrospectively collected from the databases of 45 hospitals. Patients with transverse or descending colon cancer who underwent laparoscopic or open R0 resection were registered. The primary end-points were the 3-year overall survival and relapse-free survival rates according to pathological stage. The secondary end-points were the short-term results, including blood loss, operative time, diet intake, hospital stay, and postoperative complications. RESULTS: Of the 1830 eligible patients, 872 underwent open colectomy and 958 underwent laparoscopic colectomy. The median follow-up period was 38.4 months. The conversion rate to open resection was 4.5%. The 3-year overall survival rate of the laparoscopic group was significantly higher than that of the open group for stage I patients (96.2% vs 99.2%; P = 0.04); it was also higher for stage II (94.0% vs 95.5%) and stage III (87.4% vs 90.2%) patients, but there were no significant differences. The 3-year relapse-free survival rate of the laparoscopic group was significantly higher than that of the open group for stage I patients; there were no differences between the open and laparoscopic groups among the stage II and III patients. In the multivariate analyses, laparoscopic resection was a significant factor in relapse-free survival. Laparoscopic patients had significantly lower blood loss and a significantly longer operative time than the open groups. Also, postoperative hospital stay was significantly shorter and postoperative morbidity was significantly lower in the laparoscopic group. CONCLUSION: Although this retrospective study has limitations, we can conclude that laparoscopic surgery for transverse and descending colon cancer is oncologically safe and yields better short-term results than open surgery.

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The incidence of intussusception is low in adults, particularly in the descending colon, due to the anatomical attachment of the descending colon to the retroperitoneum. Signet ring cell histology represents ~1% of colon adenocarcinomas and is associated with young patients and a poor clinical outcome. The present study describes a case of descending colo-colonic intussusception caused by signet ring cell carcinoma in a 27-year-old male. The patient presented with a history of intermittent left upper-quadrant abdominal pain for more than six months without any evident etiology. A computed tomography scan of the abdomen revealed left-sided colo-colonic intussusception. Upon laparotomy, a left hemicolectomy was performed according to intraoperative frozen-section pathology. Post-operative pathological evaluation revealed signet ring cell carcinoma invasion of the serosa, and 31.8% (7/22) of the regional lymph nodes were positive for cancerous cells. The post-operative course was uneventful and the patient was discharged on the tenth post-operative day.

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INTRODUCTION: The feasibility, safety and oncological outcomes of laparoscopic surgery for transverse and descending colon cancers in a community hospital setting were evaluated. METHODS: Twenty-six patients with transverse or descending colon cancers who underwent laparoscopic surgery at our hospital were included in this retrospective analysis (group A). Their outcomes were compared with those of 71 patients who underwent laparoscopic surgery for colon cancer at other tumor sites (group B). RESULTS: There were no significant differences between the two groups in terms of operative time, estimated blood loss, postoperative hospital stay and morbidity rate. Extended lymphadenectomy was performed more frequently and the number of harvested lymph nodes was significantly higher in group B than in group A. However, no recurrence developed in group A, while recurrence occurred in four patients from group B. The 3-year disease-free survival rates were 100% for group A and 93.5% for group B. The 3-year overall survival rates were 100% for group A and 91.6% for group B. CONCLUSIONS: Laparoscopic surgery for transverse and descending colon cancers can be performed safely with oncological validity in a community hospital setting, provided there is careful selection of the patients and adequate lymphadenectomy considering the clinical stage of their disease.

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Intussusception in adults is uncommon, and it is rare in the descending colon because of its fixation to the retroperitoneum. We herein describe a case of intussusception caused by descending colon cancer. A 74-year-old man was admitted to our hospital for treatment of vomiting and abdominal pain. He had undergone chemotherapy for lymph node recurrence of stomach cancer for about 4 years. Computed tomography revealed a 'target mass' with a tumor in the descending colon. We diagnosed his illness as intussusception of a descending colon tumor and performed emergency laparotomy. Conservative resection was performed following anastomosis after reduction of the intussusception. The tumor was pathologically diagnosed as poorly differentiated adenocarcinoma with neuroendocrine features. To the best of our knowledge, this is the first report of an intussusception caused by descending colon cancer incidentally diagnosed during chemotherapy for stomach cancer recurrence.

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PURPOSE: Many randomized clinical trials have been performed to treat a colorectal neoplasm with the exclusion of descending colon cancer. The aim of the present study was to investigate the difference in surgical outcomes between a laparoscopic left hemicolectomy and a conventional open left hemicolectomy for descending colon cancer. METHODS: A retrospective study of ninety patients with descending colon cancer, who underwent a laparoscopic (LAP) or open left hemicolectomy (OS) between May 1998 and December 2009 at Kyungpook National University Hospital, was performed. Clinicopathological and surgical outcomes were compared between the LAP and the OS for descending colon cancer. RESULTS: The baseline characteristics, including age, gender, body mass index, history of prior abdominal surgical history and tumor location, were similar between the two groups. The mean operation time was 156.2 minutes for the LAP group and 223.2 minutes for the OS group (P < 0.001). Intraoperative blood loss was significantly greater in the OS group (37.5 mL vs. 80.4 mL; P = 0.039). The postoperative recovery in the LAP group was faster, as reflected by the shorter time to pass gas and the shorter hospital stay. Pathological examinations showed the surgery to be equally radical in the two groups. The median follow-up was 21 months and there were 3 distant metastases (8.5%) during follow-up in the LAP group, but no port-site or local recurrence. CONCLUSION: A laparoscopic left hemicolectomy is a technically safe and feasible procedure for treating descending colon cancer. Prospective multi-center trials are necessary to establish the LAP as the standard treatment for descending colon cancer.

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PURPOSE: Many randomized clinical trials have been performed to treat a colorectal neoplasm with the exclusion of descending colon cancer. The aim of the present study was to investigate the difference in surgical outcomes between a laparoscopic left hemicolectomy and a conventional open left hemicolectomy for descending colon cancer. METHODS: A retrospective study of ninety patients with descending colon cancer, who underwent a laparoscopic (LAP) or open left hemicolectomy (OS) between May 1998 and December 2009 at Kyungpook National University Hospital, was performed. Clinicopathological and surgical outcomes were compared between the LAP and the OS for descending colon cancer. RESULTS: The baseline characteristics, including age, gender, body mass index, history of prior abdominal surgical history and tumor location, were similar between the two groups. The mean operation time was 156.2 minutes for the LAP group and 223.2 minutes for the OS group (P < 0.001). Intraoperative blood loss was significantly greater in the OS group (37.5 mL vs. 80.4 mL; P = 0.039). The postoperative recovery in the LAP group was faster, as reflected by the shorter time to pass gas and the shorter hospital stay. Pathological examinations showed the surgery to be equally radical in the two groups. The median follow-up was 21 months and there were 3 distant metastases (8.5%) during follow-up in the LAP group, but no port-site or local recurrence. CONCLUSION: A laparoscopic left hemicolectomy is a technically safe and feasible procedure for treating descending colon cancer. Prospective multi-center trials are necessary to establish the LAP as the standard treatment for descending colon cancer.

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