Large Intestine: Colectomy

General Colectomy Procedures

Partial Colectomy Procedures

  • Ileocecectomy: Resect the Cecum & Terminal Ileum
  • Right Hemicolectomy: Ascending Colon Resection
    • Extended Right Hemicolectomy: Ascending Colon Resection Extending to Include the Proximal Half of the Transverse Colon
  • Transverse Colectomy: Resect the Transverse Colon Including the Hepatic & Splenic Flexures
  • Left Hemicolectomy: Descending Colon Resection
    • Extended Left Hemicolectomy: Descending Colon Resection Extending to Include the Distal Half of the Transverse Colon
  • Sigmoid Colectomy/Sigmoidectomy: Sigmoid Resection

Total Colectomy Procedures

  • Subtotal Colectomy: Resect the Entire Colon Excluding the Distal Sigmoid
  • Total Abdominal Colectomy: Resect the Entire Colon
  • Total Proctocolectomy: Resect the Entire Colon and Rectum

Right Hemicolectomy 1

Transverse Colectomy 1

Left Hemicolectomy 1

Sigmoid Colectomy 1

Colectomy Extent for Cancer

General Considerations

  • Resection is Based on the Primary Tumor Location
  • Resection Margins: 5 cm
  • Complete Mesocolic Excision
    • Remove Tumor En Bloc with Mesocolon & Regional Lymphadenectomy
    • Resect Mesentery Back to the Primary Vessel Origin
    • Oncologic Resection Requires: 12 Lymph Nodes

Cecum/Ascending Colon Tumor

  • Resection: Right Hemicolectomy
    • Include 7-10 cm of Terminal Ileum
  • Blood Supply Ligated:
    • Ileocolic
    • Right Colic
    • Right Branch of the Middle Colic

Hepatic Flexure Tumor

  • Resection: Extended Right Hemicolectomy
    • Including the Proximal Half of the Transverse Colon
    • *Some Extend Past the Splenic Flexure – If Wanting to Avoid Flexure Anastomoses Due to Concern for Tension/Vascularity as it Migrates to the Original Anatomic Position
  • Blood Supply Ligated:
    • Ileocolic
    • Right Colic
    • Middle Colic

Transverse Colon Tumor

  • Resection: Transverse Colectomy
    • Include Hepatic & Splenic Flexures
    • *Consider Extended Left Hemicolectomy if Distal
  • Blood Supply Ligated:
    • Middle Colic

Splenic Flexure Tumor

  • Resection: Extended Left Hemicolectomy
  • Blood Supply Ligated:
    • Left Branch of Middle Colic
    • Left Colic

Descending Colon Tumor

  • Resection: Left Colectomy
    • *Consider Extension Past Sigmoid if Distal
  • Blood Supply Ligated:
    • Left Branch of Middle Colic
    • Left Colic
    • First Sigmoidal Vessels

Sigmoid Colon Tumor

  • Resection: Anterior Sigmoidectomy
    • *Consider Radical Left Hemicolectomy if Proximal
  • Blood Supply Ligated:
    • Portion of IMA

Anastomosis & Ostomy

Anastomosis & Anastomotic Leak

Colostomy

References

  1. Cancer Research UK. Wikimedia Commons. (License: CC BY-SA-4.0)