LAUSR

Recent studies have shown the benefits of complete mesocolic excision (CME) and extended lymphadenectomy (i.e., D3 lymph node dissection) in patients with colon cancer.1, 2 Laparoscopic surgery for colorectal cancer is less invasive,3 and laparoscopic CME or Japanese D3 is also feasible.4 However, for cases with a past history of abdominal surgery, almost no evidence is available on the usefulness of laparoscopic surgery for malignancy, as it is technically challenging in patients with a history of abdominal surgery due to severe adhesions. We performed laparoscopic para-aortic lymphadenectomy after open right hemicolectomy with partial hepatectomy and laparoscopic partial hepatectomy. In the prior two abdominal surgeries, we had not dissected the layer behind the duodenum. In a preoperative simulation we determined that the layer containing the target lesion could be safely resected even with laparoscopic surgery, as it had never been detached. After detaching the adhesions from prior surgery, Kocher mobilization was performed and the metastatic para-aortic lymph nodes, the target lesion, exposed. The lesion was then dissected carefully. The patient left the hospital 11 days after the surgery with no severe postoperative complications. Thus, the patient could restart chemotherapy more quickly after surgery or take a rest from the chemotherapy. This case suggests that, even in patients with multiple previous abdominal surgeries, laparoscopic surgery may be useful if the target lesion is in a previously undissected layer. Importantly, the number of patients with a history of multiple laparotomies is likely to increase in the future due to improvements in the results of systemic therapy.