Colon cancer may invade the adjacent organ in the absence of distant metastasis, which is called stage T4bM0 colon cancer according to the 7th edition of TNM staging system. It is not rare in clinical setting, and usually recognized intraoperatively. How to deal with this situation is a big challenge for the surgeons. It is difficult to distinguish between dense adhesion and cancerous invasion. Intraoperative biopsy should be avoided because of the risk of tumor cell dissemination and frozen often gives false-negative results. After evaluating the resectability of the tumor sufficiently, the surgeon should make every effort to do an en bloc multivisceral resection and to achieve a margin-free (R0) resection if there is no absolute contraindication. This effort will bring long-term prognosis benefit for the patients with stage cT4bM0 colon cancer.
Colonic Neoplasms ; surgery ; Humans ; Neoplasm Staging

Circumferential resection margin(CRM) is the closest distance from the deepest of tumor invasion to the surgical margin of mesentery. It has been well known that CRM has significant impact on the prognosis and treatment of rectal cancer. However, the significance of CRM of colon cancer is just brought to the forefront recently. Current evidence showed positive rate of CRM is 10%, and the patients with positive CRM have worse survival. The factors influencing CRM include tumor stage, differentiation, vascular cancer embolus, etc. Standard surgical procedure can lower the positive rate of colon CRM, and adjuvant therapy applied to the patients with positive colon CRM can improve the survival of colon cancer patients. CRM may become a new factor guiding the treatment in colon cancer patients.
Colectomy ; methods ; Colonic Neoplasms ; surgery ; Humans ; Prognosis

Colonoscopy with endoscopic resection of detected colonic adenomas interrupts the adenoma-carcinoma sequence and reduces the incidence of colorectal cancer and cancer-related mortality. In the past decade, there have been significant developments in instruments and techniques for endoscopic polypectomy. Guidelines have been formulated by various professional bodies in Europe, Japan and the United States, but some of the recommendations differ between the various bodies. An expert professional workgroup under the auspices of the Academy of Medicine, Singapore, was set up to provide guidance on the endoscopic management of colonic polyps in Singapore. A total of 23 recommendations addressed the following issues: accurate description and diagnostic evaluation of detected polyps; techniques to reduce the risk of post-polypectomy bleeding and delayed perforation; the role of specific endoscopic resection techniques; the histopathological criteria for defining endoscopic cure; and the role of surveillance colonoscopy following curative resection.
Adenoma/surgery* ; Colonic Neoplasms/surgery* ; Colonic Polyps/surgery* ; Colonoscopy/methods* ; Colorectal Neoplasms/pathology* ; Humans ; Singapore ; United States

OBJECTIVETo investigate the effect and safety of two types of early enteral nutrition, total protein(TP) and total protein with fibers(TPF-FOS), after laparoscopic colectomy.

METHODSPatients with colon cancer were divided into TP group and TPF-FOS group. Oral nutrition was given from the first postoperative day. Hemoglobin, albumin, prealbumin, white blood cell count, C-reactive protein, procalcitonin were tested before operation and on the first and seventh postoperative day. The time to first flatus, time to first bowel movement, fever, infection, and diarrhea were observed after operation.

RESULTSNo significant difference was observed in hemoglobin, albumin, prealbumin, white blood cell count, C-reactive protein, and procalcitonin between these two groups. Higher proportion of patients defecated formed stool during the observation in TPF-FOS group(76.7% vs. 27.3%, P<0.01). Less abdominal bloating was found from the fourth to the seventh postoperative day in TPF-FOS group (5.8% vs. 15.2%, P<0.05).

CONCLUSIONSBoth TP and TPF-FOS can be safely used for early oral enteral nutrition after laparoscopic colectomy. TPF-FOS may be more beneficial to the recovery of gastrointestinal function.

The precise anatomic surgery is the cornerstone of curative resection and is becoming a trend of modern surgery. Currently, there are still many inadequate resections of colon cancer continue to be performed. Complete mesocolic excision (CME) according to the surgical plane, based on the principles of oncology, is a high-quality radical operation obtaining optimal oncological pathological specimen, with precise surgical concept throughout the entire surgical procedure. CME has been proposed for three years. Although there are still some controversies, CME has set off a worldwide climax of emphasis on quality of colon surgery. It is time to focus on the quality of colon-cancer surgery in order to ensure that all patients with colon cancer receive the highest possible chance for cure.
Colonic Neoplasms ; Consensus ; Digestive System Surgical Procedures ; Humans ; Mesocolon ; surgery

Humans ; Intestinal Polyps ; Colonic Polyps/surgery* ; Intestinal Polyposis ; Colorectal Neoplasms

The mesentery is a continuous unity and the operation of digestive carcinoma is the process of mesenteric resection. This paper attempts to simplify the formation process of all kinds of fusion fascia in the process of digestive tract embryogenesis, and to illuminate the continuity of fusion fascia with a holistic concept. This is helpful for beginners to reversely dissect the fusion fascia and maintain the correct surgical plane during operation, and to achieve the purpose of complete mesenteric resection.
Colonic Neoplasms/surgery* ; Gastrointestinal Neoplasms/surgery* ; Humans ; Laparoscopy ; Mesentery/surgery* ; Mesocolon

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.
Humans ; Mesentery/surgery* ; Colonic Neoplasms/surgery* ; Colorectal Surgery ; Digestive System Surgical Procedures ; Peritoneum/surgery* ; Rectal Neoplasms/surgery* ; Laparoscopy

Delayed gastric emptying is a syndrome of gastric motility disorder with slow gastric emptying as the main sign, provided that mechanical factors such as intestinal obstruction and anastomotic stricture are excluded. The incidence of delayed gastric emptying after colon cancer surgery is 1.4%, mainly after transverse colon cancer surgery. Most of the studies on delayed gastric emptying are case reports, lacking systematic studies. The diagnoses and treatments can be draw on the experience of delayed gastric emptying after pancreatic surgery. Our retrospective study indicated that the incidence of delayed gastric emptying after surgery for transverse colon cancer was 4.0%, higher than that for other colon cancer. Patients who underwent gastrocolic ligament lymph node dissection were at higher risk than those who did not (3.6% vs. 0.8%). Gastrocolic ligament lymph node dissection and stress are causative factors for delayed gastric emptying after surgery for transverse colon cancer. We add the gastrografin test upon the diagnostic criteria of the International Study Group for Pancreatic Surgery, which is simple and practical. Nasogastric tube decompression, enteral nutrition combined with parenteral nutrition, glucocorticoids, and prokinetic agents can cure most patients with postoperative delayed gastric emptying. All the patients with postoperative delayed gastric emptying were cured in our studies. Strict indications for gastrocolic ligament lymph node dissection (patients with cT3-4 and cN+) may decrease the occurrence of delayed gastric emptying after surgery for transverse colon cancer.
Colon, Transverse/surgery* ; Colonic Neoplasms/surgery* ; Gastric Emptying ; Gastroparesis/surgery* ; Humans ; Lymph Node Excision ; Retrospective Studies

Objective: To investigate the anatomic characteristics of the left parietal peritoneum and its surgical implementation while dissecting in left retro-mesocolic space. Methods: A descriptive case series research methods was used. (1) surgical videos of 35 patients who underwent laparoscopic radical resection (complete mobilization of splenic flexure) of colorectal cancer in Union Hospital of Fujian Medical University between January 2018 and December 2018 were reviewed; (2) four specimens after radical resection of rectal cancer performing in June 2020 were prospectively enrolled and reviewed; (3) five specimens of left parietal peritoneum from 5 cadaveric abdomen (3 males and 2 females) were enrolled and reviewed as well; Tissues of 3 unseparated regions, namely the root of the inferior mesenteric artery (IMA), the medial region and the lateral region (including kidney tissue), from above the 5 cadaveric abdominal specimens were selected to perform Masson staining and histopathological examination. Results: (1) Surgical video observation: "Staggered layer phenomenon" and typical left parietal peritoneum was found in 77.1% (27/35) of patients when the left retro-mesocolic space was separated from the lateral and central approaches. The left parietal peritoneum presented as a rigid fascia barrier between the lateral and central approaches, which was a translucent dense connective tissue fascia. After the splenic flexure were completely mobilized, the left parietal peritoneum stump continued to the cephalic side. (2) Observation of 4 surgical specimens: The dorsal side of the left mesocolon specimen was studied, and the left parietal peritoneum stump edge was identified. The outside of the stump edge was the left hemicolon dorsal layer, which was continuously downward to the rectal fascia propria. (3) Cadaveric abdominal specimens: The left retro-mesocolic space was separated through lateral and central approaches, and the rigid fascia barrier, essentially the left parietal peritoneum and Gerota fascia, was encountered. Cross-section view showed that the left parietal peritoneum could be further detached from the dorsal layer of the left mesocolon from the outside, but could not be further detached from the inside out. (4) Histological examination: There was no obvious fascia structure in the IMA root region, while outside the IMA root region, the left bundle of inferior mesenteric plexus penetrating Gerota fascia was observed. There were 4 layers of fascias in the medial region, including the ventral layer of the left mesocolon, the dorsal layer of the left mesocolon, left parietal peritoneum and Gerota fascia. Small vessels were observed between the dorsal layer of the left mesocolon and the left parietal peritoneum. In lateral region, renal tissue and renal fascia were observed. Three layers of fascia structures were observed clearly under high power field, including the dorsal layer of the left mesocolon, left parietal peritoneum, and Gerota fascia. Conclusions: The left parietal peritoneum is the anatomical basis of the "staggered layer phenomenon" from the lateral or central approaches during the separation of left retro-mesocolic space. The small vessels in the dissection plane are the anatomical basis of intraoperative microbleeding, which need pre-coagulation. The central part of Gerota fascia is penetrated by the branches of the inferior mesenteric plexus, which results in a relatively dense surgical plane. Thus, during the dissection through the central approach, it is easy to involve in wrong surgical plane by deeper dissection.
Colon, Transverse ; Colonic Neoplasms/surgery* ; Dissection ; Female ; Humans ; Laparoscopy ; Male ; Mesocolon ; Peritoneum ; Rectal Neoplasms/surgery*