[Transverse Colectomy with D2 Lymph Node Dissection with a Small Incision Using Body Surface 3D-Simulation CT...

Area of Science:

• Surgical Oncology
• Medical Imaging
• Gastrointestinal Surgery

Background:

• Laparoscopic transverse colectomy presents technical challenges, particularly for D2 lymph node dissection.
• Mini-laparotomy offers an alternative for transverse colectomy but faces difficulties in precise lymph node dissection due to complex vascular anatomy.

Observation:

• A 60-year-old woman with mid-transverse colon cancer underwent surgical treatment.
• CT colonography (CTC) and 3D imaging were used to identify tumor location and simulate D2 lymph node dissection, including identifying the dominant artery (MCA Rt) and its accompanying vein (GCT).
• Body surface 3D-sCTC was employed to simulate the minimum incision for D2 lymph node dissection.

Findings:

• Simulation identified the right branch of the middle colic artery (MCA Rt) and its accompanying vein from the gastrocolic trunk (GCT).
• A 7 cm upper abdominal midline incision and a 2 cm umbilical incision were simulated and utilized for the mini-laparotomy transverse colectomy.
• The surgery was completed in 2 hours and 51 minutes with minimal blood loss. The patient recovered well and had no recurrence for over 4 years.

Implications:

• 3D-CT imaging, specifically body surface 3D-sCTC, enables accurate D2 lymph node dissection during mini-laparotomy transverse colectomy.
• This technique is a potential treatment option for early transverse colon cancer, offering a minimally invasive approach.
• The simulated incision size and location led to favorable cosmetic outcomes post-surgery.