Left hemicolectomy for colon cancer: from fascial anatomy theory to clinical practice
10.3760/cma.j.cn441530-20250711-00261
- VernacularTitle:左半结肠癌根治术：从膜解剖理论到临床实践
- Author:
Pan CHI
1
;
Xiaojie WANG
1
Author Information
1. 福建医科大学附属协和医院结直肠外科，福州 350001
- Publication Type:Journal Article
- Keywords:
Colon neoplasms, left colon;
Left hemicolectomy;
Fascial anatomy;
Splenic flexure mobilization
- From:
Chinese Journal of Gastrointestinal Surgery
2025;28(9):969-977
- CountryChina
- Language:Chinese
-
Abstract:
Left hemicolectomy is predominantly utilized for the management of carcinomas located at the splenic flexure, descending colon, and sigmoid colon. The incidence of carcinomas at the splenic flexure and descending colon is comparatively low. With advancements in therapeutic modalities, there has been a progressive improvement in the prognosis of left colon cancer. Presently, the oncological outcomes following radical resection for non-metastatic left colon carcinoma are marginally superior to those observed in right colon carcinoma. The vascular supply to the splenic flexure is subject to variability, encompassing arteries originating from both the superior mesenteric artery and the inferior mesenteric artery systems. Its distinctive anatomical location and intricate lymphatic drainage have sparked debates regarding the appropriate extent of surgical resection. Recent research has demonstrated that adherence to the "10 cm" principle for left hemicolectomy is justified, and a minimal resection of the splenic flexure is adequate. The scope of lymph node dissection can be ascertained based on the positive rate of each lymph node station, with station 253 not necessitating dissection. However, when the accessory middle colic artery is present, it should be regarded as the primary vascular supply for D3 dissection. Furthermore, advancements in the study of fascial anatomy related to the left colon have yielded new perspectives in the surgical management of carcinoma at the splenic flexure left colon carcinoma. The extra-omental sac dissection, which is grounded in the principles of fascial anatomy, facilitates the safe and efficient mobilization of the splenic flexure colon.
