VIDEO VIGNETTE
Laparoscopic En Bloc Resection of T4 Colon Cancer
Invading the Spleen and Pancreatic Tail
Tzu-Chun Chen, M.D.1 Jin-Tung Liang, M.D., Ph.D.2
1 Division of Colorectal Surgery, Department of Surgery, Hsinchu Branch, National Taiwan University Hospital, Hsinchu, Taiwan
2 Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei,
Taiwan
T
he advantages of a laparoscopic approach for T4
colon cancer resection remain obscure because of
the concerns about technical difficulty, as evaluat-
ed by operative time, conversion rate, intra- and postop-
erative complications, wound length needed for retrieval
of a large tumor mass, and, most importantly, oncologic
efficacy. However, many reports have stated that laparo-
scopic surgery is not contraindicated for T4 colon can-
cer and that it provides clinical and oncologic outcomes
comparable to those obtained using traditional open sur-
gery.15 It is encouraging that laparoscopic surgery results
in comparably less blood loss and a shorter postopera-
tive hospitalization period than open surgery.1,2 T4 colon
cancer invasion of the following organs has been treated
using laparoscopic surgery: abdominal wall, kidney, blad-
der, ureter, ovary/uterus, prostate/seminal vesicles, gall-
bladder, small bowel, and duodenum.1,2,6 However, the
application of laparoscopic surgery to treat T4 colon can-
cer invading the spleen and pancreatic tail has rarely been
reported. Most en bloc multivisceral resections of the
spleen and distal pancreas, in conjunction with T4 c olonic
adenocarcinoma located at the colonic splenic flexure,
have been performed by using traditional open surgery.7,8
At our institution, we have demonstrated that colectomy,
combined with splenectomy and distal pancreatectomy,
can be safely performed laparoscopically with accept-
able oncologic outcomes and rapid c onvalescence. In this
Supplemental digital content is available for this article. Direct URL
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Financial Disclosures: None reported.
Correspondence: Jin-Tung Liang, M.D., Ph.D., Division of Colorectal
Surgery, Department of Surgery, National Taiwan University Hospital,
No.7, Chung-Shan South Rd, Taipei, Taiwan. E-mail: jintung@ntu.edu.tw
Dis Colon Rectum 2016; 59: 581582
DOI: 10.1097/DCR.0000000000000584
The ASCRS 2016
Diseases of the Colon & Rectum Volume 59: 6 (2016)
Copyright The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited.
video (http://links.lww.com/DCR/A228), the index case
is a 55-year-old man with a diagnosis of distal transverse
colon cancer with direct invasion of the splenic hilum
and pancreatic tail. The patient was successfully treated
by a laparoscopic approach. Encouraged by the techni-
cal feasibility, better functional recovery, and acceptable
short-term oncologic outcomes of laparoscopic surgery
for such a patient subset, we have changed our treatment
policy for patients with T4 colon cancer requiring en bloc
distal pancreatectomy and splenectomy in addition to
standard left hemicolectomy,9 and we now recommend
this laparoscopic surgery for a large proportion of such
patients after precise clinical staging.
KEY WORDS: Laparoscopy; T4 colon cancer; Multiorgan
resection; Splenectomy; Distal pancreatectomy.
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