{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T03:03:01Z","timestamp":1740106981398,"version":"3.37.3"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T00:00:00Z","timestamp":1626393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005389","name":"Universit\u00e0 degli Studi dell'Insubria","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005389","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Technique and methods<\/jats:title>\n                <jats:p>Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00423-021-02240-7","type":"journal-article","created":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T06:02:57Z","timestamp":1626415377000},"page":"421-428","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels"],"prefix":"10.1007","volume":"407","author":[{"given":"Salomone","family":"Di Saverio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kostantinos","family":"Stasinos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weronyka","family":"Stupalkowska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umberto","family":"Bracale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierpaolo","family":"Sileri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Giuliani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Nigri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efstratios","family":"Kouroumpas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James M. D.","family":"Wheeler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni Domenico","family":"Tebala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Di Marzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"De Simone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos Pastor","family":"Idoate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"De Angelis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Cirocchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Tejedor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,16]]},"reference":[{"key":"2240_CR1","doi-asserted-by":"publisher","unstructured":"Mesenteric and peritoneal anatomy: basic and applied science\u2013chapter 12, Taylor & Fancis, March 2017, https:\/\/doi.org\/10.1201\/9781315381565-2, In book: Mesenteric principles of gastrointestinal surgery","DOI":"10.1201\/9781315381565-2"},{"key":"2240_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-07431-9","author":"N de\u2019Angelis","year":"2020","unstructured":"de\u2019Angelis N, Mart\u00ednez-P\u00e9rez A, Winter DC et al (2020) Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis. Surg Endosc. https:\/\/doi.org\/10.1007\/s00464-020-07431-9","journal-title":"Surg Endosc"},{"key":"2240_CR3","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-07078-1","author":"U Bracale","year":"2019","unstructured":"Bracale U, Merola G, Pignata G et al (2019) Laparoscopic resection with complete mesocolic excision for splenic flexure cancer: long-term follow-up data from a multicenter retrospective study. Surg Endosc. https:\/\/doi.org\/10.1007\/s00464-019-07078-1","journal-title":"Surg Endosc"},{"issue":"10","key":"2240_CR4","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1097\/DCR.0000000000001743","volume":"63","author":"M Degiuli","year":"2020","unstructured":"Degiuli M, Reddavid R, Ricceri F, Di Candido F, Ortenzi M, Elmore U, Belluco C, Rosati R, Guerrieri M, Spinelli A, Members of the Italian Society of Surgical Oncology Colorectal Cancer Network (SICO-CCN) Collaborative Group (2020) Segmental colonic resection is a safe and effective treatment option for colon cancer of the splenic flexure: a nationwide retrospective study of the Italian Society of Surgical Oncology-Colorectal Cancer Network Collaborative Group. Dis Colon Rectum 63(10):1372\u20131382. https:\/\/doi.org\/10.1097\/DCR.0000000000001743","journal-title":"Dis Colon Rectum"},{"issue":"1","key":"2240_CR5","doi-asserted-by":"publisher","first-page":"10953","DOI":"10.1038\/s41598-019-47548-z","volume":"9","author":"D Rega","year":"2019","unstructured":"Rega D, Pace U, Scala D, Chiodini P, Granata V, Fares Bucci A, Pecori B, Delrio P (2019 Jul 29) Treatment of splenic flexure colon cancer: a comparison of three different surgical procedures: Experience of a high volume cancer center. Sci Rep 9(1):10953. https:\/\/doi.org\/10.1038\/s41598-019-47548-z","journal-title":"Sci Rep"},{"issue":"2","key":"2240_CR6","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1007\/s00384-020-03763-z","volume":"36","author":"X Wang","year":"2021","unstructured":"Wang X, Zheng Z, Chen M, Lu X, Huang S, Huang Y, Chi P (2021 Feb) Subtotal colectomy, extended right hemicolectomy, left hemicolectomy, or splenic flexure colectomy for splenic flexure tumors: a network meta-analysis. 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Lancet Oncol 16(2):161\u2013168. https:\/\/doi.org\/10.1016\/S1470-2045(14)71168-4","journal-title":"Lancet Oncol"}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-021-02240-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-021-02240-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-021-02240-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,16]],"date-time":"2022-02-16T04:38:15Z","timestamp":1644986295000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00423-021-02240-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,16]]},"references-count":7,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,2]]}},"alternative-id":["2240"],"URL":"https:\/\/doi.org\/10.1007\/s00423-021-02240-7","relation":{},"ISSN":["1435-2443","1435-2451"],"issn-type":[{"type":"print","value":"1435-2443"},{"type":"electronic","value":"1435-2451"}],"subject":[],"published":{"date-parts":[[2021,7,16]]},"assertion":[{"value":"11 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Written consent is obtained and available upon request.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Written consent"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}