[Fascial anatomy of ligamentous structures associated with colon cancer surgery].

Abstract

The ligamentous structures integral to the surgical management of colon cancer include the gastrocolic ligament, the phrenicocolic ligament, and the splenocolic ligament. Historically, the era of conventional open surgery was characterized by the use of large forceps for clamping and ligating these ligaments. However, the advent of fascial and mesenteric anatomy research has ushered in a paradigm shift. Aided by high-definition laparoscopy, colorectal surgeons have progressively clarified the fundamental anatomical structures, thereby refining surgical techniques in accordance with fascial and mesenteric anatomical principles. This study synthesizes the author's anatomical research findings to dissect the fascial and mesenteric anatomy of the ligaments pertinent to colon cancer surgery, thereby exploring their implications for surgical practice and oncological outcomes. The gastrocolic ligament exhibits distinct fascial and mesenteric anatomical configurations within the omental sac and extra-omental regions. Within the omental sac, the sub-omental arch pathway emerges as a viable alternative to the paracolic approach for accessing the omental sac through the gastrocolic ligament. Conversely, in the extra-omental region, the incision of the greater omentum overlaying the space between the mesogastrium and the transverse mesocolon represents a mesenteric bridge facilitating access to this area. The incidence of nodal metastasis in the gastrocolic ligament associated with transverse colon and hepatic flexure colon cancer is notably low; nevertheless, selective dissection in high-risk patients can still provide survival benefits. The splenocolic ligament is formed by the convergence of the splenic hilum region of the mesogastrium (including the pancreatic mesentery) with the mesocolon of the splenic flexure of the colon. A natural avascular plane exists within it, and dissection along this plane can avoid encountering the branches of the left gastroepiploic artery that are typically encountered in traditional dissection routes. To date, there is no compelling evidence advocating for the resection of the splenic hilum region of the mesogastrium or the lymph nodes of the gastrocolic ligament in the context of splenic flexure colon cancer.