Vascular anatomical study of persistent descending mesocolon in patients undergoing laparoscopic surgery for colorectal cancer.

INTRODUCTION: Persistent descending mesocolon (PDM) is a rare congenital atypia of fixation of the descending colon, and currently, very few detailed studies exist on its vascular anatomy. This study was conducted to evaluate the features of the vascular anatomy of PDM to help avoid intraoperative lethal injury and subsequent postoperative complications in laparoscopic colorectal surgery. METHODS: We retrospectively analyzed the data of 534 patients who underwent laparoscopic left-sided colorectal surgery. PDM was diagnosed using preoperative axial computed tomography (CT) view. The vascular anatomical features were compared between PDM and non-PDM cases based on three-dimensional (3D)-CT angiography findings. Additionally, the perioperative short-term outcomes of laparoscopic surgery in the 534 patients were also compared between PDM and non-PDM cases. RESULTS: Of the total 534 patients, 13 patients (2.4%) presented with PDM. No branching pattern of the inferior mesenteric artery (IMA) specific to PDM was found. In the running direction of the IMA and sigmoidal colic artery (SA), the midline-shift of IMA and the right-shift of SA were significantly more in PDM than in non-PDM cases, respectively (38.5% vs. 2.5%, P ≤ .0001; 61.5% vs. 4.6%, P ≤ .0001). The perioperative short-term outcomes of laparoscopic surgery in the 534 patients were similar between PDM and non-PDM cases. CONCLUSION: Because changes in the direction of the vascular running are often observed due to adhesions and shortening of the mesentery in PDM cases, performing a detailed preoperative evaluation of vascular anatomy using imaging modalities such as 3D-CT angiography is important.

Incisional surgical site infection after elective open surgery for colorectal cancer.

BACKGROUND: The purpose of this study was to clarify the incidence and risk factors for incisional surgical site infections (SSI) in patients undergoing elective open surgery for colorectal cancer. METHODS: We conducted prospective surveillance of incisional SSI after elective colorectal resections performed by a single surgeon for a 1-year period. Variables associated with infection, as identified in the literature, were collected and statistically analyzed for their association with incisional SSI development. RESULTS: A total of 224 patients were identified for evaluation. The mean patient age was 67 years, and 120 (55%) were male. Thirty-three (14.7%) patients were diagnosed with incisional SSI. Multivariate analysis suggested that incisional SSI was independently associated with TNM stages III and IV (odds ratio [OR], 2.4) and intraoperative hypotension (OR, 3.4). CONCLUSIONS: The incidence of incisional SSI in our cohort was well within values generally reported in the literature. Our data suggest the importance of the maintenance of intraoperative normotension to reduce the development of incisional SSI.