Live surgerySeptember 15, 20221:46:177 speakersAvailable in: EN / IT
Clinical Round: Left Colon Cancer - ICG-Guided Resection
Fifth ICG-School Clinical Round: a case of left colon adenocarcinoma in a young patient, with discussion on ICG fluorescence for lymph node navigation and anastomotic perfusion.
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Clinical case
Adenocarcinoma del colon discendente-sigma (a 50 cm dall'orifizio anale)
DiagnosisAdenocarcinoma del colon discendente-sigma (a 50 cm dall'orifizio anale)
Prior treatmentOrchiectomia per k testicolare 10 anni prima
Clinical historyPaziente sportivo, magro, in eccellenti condizioni generali. Pregressa orchiectomia 10 anni prima per carcinoma testicolare senza linfadenectomia. Dolori addominali da 2 anni in fossa iliaca sinistra senza alterazioni dell'alvo. Sangue occulto positivo (3/3), PCR lievemente mossa, non anemico.
NotesCaso real-life di un mesetto prima dell'episodio; nessuna terapia neoadiuvante; dibattito finale sull'indicazione ad adiuvante FOLFOX nonostante N0.
Overview
The fifth Clinical Round of the Permanent School on ICG Surgery, hosted by Gian Luca Baiocchi (Cremona), addresses a real case of descending-sigmoid colon adenocarcinoma in a young, athletic man with a history of orchiectomy for testicular cancer. Senior guests in the discussion are Gabriele Anania (Ferrara) and Umberto Bracale (Naples/Salerno), with the participation of Sergio Sandrucci and residents from Turin and Messina. The case is followed from the initial clinical presentation (ultrasound suspicion, CT uncertainty between inflammation and neoplasm presented by radiologist Barbara Frittoli) through to colonoscopic diagnosis and the operative pathway.
The laparoscopic live surgery shows the technique of endoscopic ICG marking with glycerol performed the day before, allowing excellent visualization of the periaortic lymph nodes and the distribution along the inferior mesenteric artery. The choice between high and low ligation of the mesenteric artery with preservation of the left colic artery is discussed in depth: Baiocchi argues for the vascular advantage of fluorescence-guided low ligation, Bracale prefers systematic high ligation, while Anania tailors the choice to the case. The mobilization of the splenic flexure (on demand vs systematic), timing of vascular/mesenteric section, and the use of a transanal trocar with endoluminal ICG to check anastomotic perfusion and integrity are also addressed.
The episode integrates reflections on preoperative preparation (mechanical and antibiotic), access (Veress vs Open), use of three-row circular staplers, and assessment of the final histology (pT3N0) with debate on the appropriateness of adjuvant FOLFOX in a young patient. The central message that emerges is that ICG fluorescence is now well established for the assessment of anastomotic perfusion, while lymph node navigation remains a research field of mainly anatomical value and potentially useful in organ-sparing strategies.
Topics
ICG fluorescence in colorectal surgery
Lymph node navigation
Anastomotic perfusion
High vs low ligation of the inferior mesenteric artery
Preservation of the left colic artery
Splenic flexure mobilization
Endoscopic ICG marking with glycerol
Mechanical and antibiotic preoperative preparation
Laparoscopic access: Veress vs Open
Transanal anastomotic check
Diagnostic workup: CT vs colonoscopy
Indications for adjuvant therapy in colon cancer
Tools used
Verde di indocianina (ICG)Stryker (sistema fluorescenza)Glicerolo per iniezione endoscopicaTrocar laparoscopici (10 e 5 mm)Ago di VerresSuturatrice circolare 29/31 mmSuturatrice lineare endoscopicaTrocar Hasson con palloncinoTC con mdc
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